CMS Formulary

Displaying 65861-65870 of 1611142 results.
ID: 65861
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 403922
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 65862
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 402109
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 65863
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 834235
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 65864
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 834241
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 65865
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 359144
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 65866
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 359145
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 65867
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 1000076
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 65868
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 1298088
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 65869
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 1298091
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 65870
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 242892
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 8
Qty Limit Days: 28