CMS Formulary

Displaying 5131-5140 of 1611142 results.
ID: 5131
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2361300
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 300
Qty Limit Days: 30
ID: 5132
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2361296
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 5133
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2174390
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 56
Qty Limit Days: 28
ID: 5134
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1243052
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 56
Qty Limit Days: 28
ID: 5135
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1606866
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 56
Qty Limit Days: 28
ID: 5136
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2257013
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 84
Qty Limit Days: 28
ID: 5137
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1606870
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 56
Qty Limit Days: 28
ID: 5138
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2053519
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 56
Qty Limit Days: 28
ID: 5139
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2166401
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 56
Qty Limit Days: 28
ID: 5140
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1999389
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 56
Qty Limit Days: 28