CMS Formulary

Displaying 45301-45310 of 1611142 results.
ID: 45301
Formulary ID: 00021015
Formulary Version: 14
Contract Year: 2021
RXCUI: 830845
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 45302
Formulary ID: 00021015
Formulary Version: 14
Contract Year: 2021
RXCUI: 830837
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 45303
Formulary ID: 00021015
Formulary Version: 14
Contract Year: 2021
RXCUI: 830801
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 45304
Formulary ID: 00021015
Formulary Version: 14
Contract Year: 2021
RXCUI: 352257
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 540
Qty Limit Days: 30
ID: 45305
Formulary ID: 00021015
Formulary Version: 14
Contract Year: 2021
RXCUI: 2393794
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 540
Qty Limit Days: 30
ID: 45306
Formulary ID: 00021015
Formulary Version: 14
Contract Year: 2021
RXCUI: 2121764
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 45307
Formulary ID: 00021015
Formulary Version: 14
Contract Year: 2021
RXCUI: 2173841
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 45308
Formulary ID: 00021015
Formulary Version: 14
Contract Year: 2021
RXCUI: 1364477
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 45309
Formulary ID: 00021015
Formulary Version: 14
Contract Year: 2021
RXCUI: 1602028
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 45310
Formulary ID: 00021015
Formulary Version: 14
Contract Year: 2021
RXCUI: 1602034
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28