CMS Formulary

Displaying 40841-40850 of 1611142 results.
ID: 40841
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 212787
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 40842
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 1312408
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 84
Qty Limit Days: 28
ID: 40843
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 1439894
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 40844
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 1439896
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 40845
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 1439899
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 40846
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 1439901
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 40847
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 1439903
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 40848
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 2105657
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 40849
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 2105645
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 40850
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 2105653
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 300
Qty Limit Days: 30