CMS Formulary

Displaying 42721-42730 of 1611142 results.
ID: 42721
Formulary ID: 00021015
Formulary Version: 14
Contract Year: 2021
RXCUI: 643066
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 42722
Formulary ID: 00021015
Formulary Version: 14
Contract Year: 2021
RXCUI: 1652084
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 42723
Formulary ID: 00021015
Formulary Version: 14
Contract Year: 2021
RXCUI: 1006801
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 42724
Formulary ID: 00021015
Formulary Version: 14
Contract Year: 2021
RXCUI: 996921
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 42725
Formulary ID: 00021015
Formulary Version: 14
Contract Year: 2021
RXCUI: 721773
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 42726
Formulary ID: 00021015
Formulary Version: 14
Contract Year: 2021
RXCUI: 476179
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 42727
Formulary ID: 00021015
Formulary Version: 14
Contract Year: 2021
RXCUI: 476177
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 42728
Formulary ID: 00021015
Formulary Version: 14
Contract Year: 2021
RXCUI: 199703
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 42729
Formulary ID: 00021015
Formulary Version: 14
Contract Year: 2021
RXCUI: 1359129
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 42730
Formulary ID: 00021015
Formulary Version: 14
Contract Year: 2021
RXCUI: 485440
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30