CMS Formulary

Displaying 52121-52130 of 1611142 results.
ID: 52121
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 2055815
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 52122
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 1441740
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 52123
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 835721
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 52124
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 1046920
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 1008
Qty Limit Days: 90
ID: 52125
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 404457
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 52126
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 404458
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 52127
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 404459
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 52128
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 1549456
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 52129
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 1549454
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 52130
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 205562
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0