CMS Formulary

Displaying 52221-52230 of 1611142 results.
ID: 52221
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 197731
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 52222
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 864761
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 1200
Qty Limit Days: 30
ID: 52223
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 864769
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 600
Qty Limit Days: 30
ID: 52224
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 315187
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 52225
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 856724
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 52226
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 856733
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 52227
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 309371
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 52228
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 197577
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 52229
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 343033
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 52230
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 197579
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0