CMS Formulary

Displaying 5081-5090 of 1611142 results.
ID: 5081
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 207059
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 15
Qty Limit Days: 30
ID: 5082
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 211140
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 5083
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 706831
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 5084
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 706827
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 5085
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 706829
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 5086
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 706825
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 5087
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 858074
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 0
Qty Limit Days: 28
ID: 5088
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 858051
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 0
Qty Limit Days: 28
ID: 5089
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 858057
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 0
Qty Limit Days: 28
ID: 5090
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 858055
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28