CMS Formulary

Displaying 4481-4490 of 1611142 results.
ID: 4481
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2055676
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 30
ID: 4482
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2055672
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 30
ID: 4483
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 314111
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 4484
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 858798
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 150
Qty Limit Days: 30
ID: 4485
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 197738
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 4486
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 311725
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 4487
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 311726
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 4488
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 884386
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 4489
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 884385
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 4490
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 993770
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 30