CMS Formulary

Displaying 54501-54510 of 1611142 results.
ID: 54501
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 686418
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 54502
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 835829
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 54503
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 860975
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 54504
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 860981
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 54505
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 312136
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 54506
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 312137
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 54507
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 1299911
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 54508
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 855861
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 54509
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 197890
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 54510
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 855873
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0