CMS Formulary

Displaying 4301-4310 of 1611142 results.
ID: 4301
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 805515
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 4302
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 603378
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 4303
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1190225
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 8
Qty Limit Days: 30
ID: 4304
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 580261
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 4305
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 836368
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 25
Qty Limit Days: 28
ID: 4306
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1552004
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 30
ID: 4307
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1723478
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 4308
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1430453
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 4309
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1430457
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 4310
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1100706
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30