CMS Formulary

Displaying 5371-5380 of 1611142 results.
ID: 5371
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 853356
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5372
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 848164
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5373
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1653144
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5374
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1482814
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5375
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1653166
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5376
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1100079
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 5377
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1918044
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 5378
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1928689
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5379
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2118741
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5380
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2000019
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 28
Qty Limit Days: 28