CMS Formulary

Displaying 50461-50470 of 1611142 results.
ID: 50461
Formulary ID: 00021017
Formulary Version: 14
Contract Year: 2021
RXCUI: 311995
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 50462
Formulary ID: 00021017
Formulary Version: 14
Contract Year: 2021
RXCUI: 1648759
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 50463
Formulary ID: 00021017
Formulary Version: 14
Contract Year: 2021
RXCUI: 1307061
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 50464
Formulary ID: 00021017
Formulary Version: 14
Contract Year: 2021
RXCUI: 1115698
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 540
Qty Limit Days: 180
ID: 50465
Formulary ID: 00021017
Formulary Version: 14
Contract Year: 2021
RXCUI: 1308569
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 50466
Formulary ID: 00021017
Formulary Version: 14
Contract Year: 2021
RXCUI: 351209
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 50467
Formulary ID: 00021017
Formulary Version: 14
Contract Year: 2021
RXCUI: 197623
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 50468
Formulary ID: 00021017
Formulary Version: 14
Contract Year: 2021
RXCUI: 2055650
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 50469
Formulary ID: 00021017
Formulary Version: 14
Contract Year: 2021
RXCUI: 1099808
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 50470
Formulary ID: 00021017
Formulary Version: 14
Contract Year: 2021
RXCUI: 1484296
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0