CMS Formulary

Displaying 4261-4270 of 1611142 results.
ID: 4261
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 861427
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 4262
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 991086
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 4263
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 314006
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 4264
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 315107
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 4265
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 310489
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 4266
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 722122
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 4267
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 722116
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 4268
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 198250
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 4269
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 197502
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 4270
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 897612
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0