CMS Formulary

Displaying 52241-52250 of 1611142 results.
ID: 52241
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 312617
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 52242
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 198144
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 52243
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 198146
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 52244
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 213272
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 52245
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 207100
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 52246
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 804547
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 52247
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 1307630
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 52248
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 1307635
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 52249
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 1243010
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 52250
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 1243014
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30