CMS Formulary

Displaying 5141-5150 of 1611142 results.
ID: 5141
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1812470
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 5142
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1655934
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 5143
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2053512
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 56
Qty Limit Days: 28
ID: 5144
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 904158
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5145
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 861495
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5146
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 197407
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5147
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 310364
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5148
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 238920
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5149
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 861487
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5150
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1992281
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0