CMS Formulary

Displaying 4861-4870 of 1611142 results.
ID: 4861
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2122650
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 4862
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2122648
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 4863
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2122642
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 4864
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2477272
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 4865
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 795749
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 4866
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1809520
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 4867
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 239189
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 4868
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1665107
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 4869
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 309072
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 4870
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 863538
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0