CMS Formulary

Displaying 43771-43780 of 1611142 results.
ID: 43771
Formulary ID: 00021015
Formulary Version: 14
Contract Year: 2021
RXCUI: 905041
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 43772
Formulary ID: 00021015
Formulary Version: 14
Contract Year: 2021
RXCUI: 905092
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 43773
Formulary ID: 00021015
Formulary Version: 14
Contract Year: 2021
RXCUI: 905100
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 43774
Formulary ID: 00021015
Formulary Version: 14
Contract Year: 2021
RXCUI: 1095712
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 43775
Formulary ID: 00021015
Formulary Version: 14
Contract Year: 2021
RXCUI: 1665515
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 43776
Formulary ID: 00021015
Formulary Version: 14
Contract Year: 2021
RXCUI: 1719286
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 43777
Formulary ID: 00021015
Formulary Version: 14
Contract Year: 2021
RXCUI: 313115
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 43778
Formulary ID: 00021015
Formulary Version: 14
Contract Year: 2021
RXCUI: 239240
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 43779
Formulary ID: 00021015
Formulary Version: 14
Contract Year: 2021
RXCUI: 809871
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 20
Qty Limit Days: 30
ID: 43780
Formulary ID: 00021015
Formulary Version: 14
Contract Year: 2021
RXCUI: 864661
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0