CMS Formulary

Displaying 5331-5340 of 1611142 results.
ID: 5331
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1648162
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5332
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1648160
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5333
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2048718
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 5334
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2048722
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 5335
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1991509
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5336
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1865962
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5337
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 197699
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5338
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 197700
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5339
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 596926
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 5340
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 596930
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30