CMS Formulary

Displaying 5121-5130 of 1611142 results.
ID: 5121
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 198035
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5122
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 198036
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5123
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1193341
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 5124
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1193337
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 5125
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1193345
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 5126
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1193349
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 5127
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1193353
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 5128
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2359344
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 14
Qty Limit Days: 21
ID: 5129
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2359348
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 14
Qty Limit Days: 21
ID: 5130
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2359340
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 14
Qty Limit Days: 21