CMS Formulary

Displaying 54361-54370 of 1611142 results.
ID: 54361
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 617311
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 54362
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 310818
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 54363
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 259255
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 54364
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 905028
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28
ID: 54365
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 905024
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 54366
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 577208
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 54367
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 205328
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 54368
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 314155
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 54369
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 351107
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 54370
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 859193
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0