CMS Formulary

Displaying 40071-40080 of 1611142 results.
ID: 40071
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 197383
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 40072
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 197382
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 40073
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 805515
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 40074
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 603378
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 40075
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 1190225
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 8
Qty Limit Days: 30
ID: 40076
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 580261
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 40077
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 836368
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 25
Qty Limit Days: 28
ID: 40078
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 1552004
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 30
ID: 40079
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 1723478
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 40080
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 1430453
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30