CMS Formulary

Displaying 4091-4100 of 1611142 results.
ID: 4091
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 245136
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 10
Qty Limit Days: 30
ID: 4092
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 245134
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 10
Qty Limit Days: 30
ID: 4093
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 245135
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 10
Qty Limit Days: 30
ID: 4094
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 197696
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 10
Qty Limit Days: 30
ID: 4095
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1870650
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 4096
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 829762
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 4097
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1191234
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 4098
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1724338
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 4099
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1658637
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 4100
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 307718
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0