CMS Formulary

Displaying 4961-4970 of 1611142 results.
ID: 4961
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1870207
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 30
ID: 4962
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1374574
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 224
Qty Limit Days: 28
ID: 4963
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2003255
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 4964
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2198370
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 4965
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 865208
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 4966
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 865212
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 4967
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 865216
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 4968
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 723827
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 4969
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 729201
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 4970
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 729203
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0