CMS Formulary

Displaying 5091-5100 of 1611142 results.
ID: 5091
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 858053
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28
ID: 5092
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2059017
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 5093
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1232084
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 5094
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1232088
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 5095
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1114202
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 5096
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1549683
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5097
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1650968
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 0
Qty Limit Days: 84
ID: 5098
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1650972
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 84
ID: 5099
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1650974
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 84
ID: 5100
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1650976
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 84