CMS Formulary

Displaying 4141-4150 of 1611142 results.
ID: 4141
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1433235
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 4142
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1433241
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 4143
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1307309
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 4144
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2052609
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 4145
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2052704
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 4146
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2105817
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 4147
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1300797
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 4148
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1300803
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 4149
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 967388
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 4150
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 307730
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0