CMS Formulary

Displaying 631-640 of 1611142 results.
ID: 631
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 1666334
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 632
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 1116639
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 633
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 1872261
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 634
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 2055008
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 635
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 991233
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 636
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 308047
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 637
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 308048
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 638
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 197321
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 639
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 197322
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 150
Qty Limit Days: 30
ID: 640
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 198033
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0