CMS Formulary

Displaying 52381-52390 of 1611142 results.
ID: 52381
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 1923054
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 49
Qty Limit Days: 28
ID: 52382
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 1801840
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 52383
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 1923056
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 70
Qty Limit Days: 28
ID: 52384
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 1923058
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 91
Qty Limit Days: 28
ID: 52385
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 2002719
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 52386
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 2058981
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 52387
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 2123314
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 52388
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 2121096
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 112
Qty Limit Days: 28
ID: 52389
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 2121100
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 52390
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 2390954
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28