CMS Formulary

Displaying 5291-5300 of 1611142 results.
ID: 5291
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 314215
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 5292
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 312836
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 5293
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 311277
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 5294
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1099563
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5295
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 904932
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28
ID: 5296
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 313758
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5297
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 199655
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5298
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 349208
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5299
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 360110
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5300
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 206913
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0