CMS Formulary

Displaying 5101-5110 of 1611142 results.
ID: 5101
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1739766
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 5102
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1739774
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 5103
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2173500
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 10
Qty Limit Days: 30
ID: 5104
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1739778
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 5105
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1739782
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 5106
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 795085
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5107
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 849599
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5108
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1739770
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 5109
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1251914
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 5110
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 722256
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30