CMS Formulary

Displaying 4391-4400 of 1611142 results.
ID: 4391
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 645884
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 4392
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 754508
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 6
Qty Limit Days: 28
ID: 4393
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 197411
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 4394
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 310600
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 4395
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 403850
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 4396
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 810090
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 4397
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 403851
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 4398
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 810083
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 4399
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 403852
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 4400
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 730988
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0