CMS Formulary

Displaying 54721-54730 of 1611142 results.
ID: 54721
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 854925
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 54722
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 904431
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 54723
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 312087
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 54724
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 198334
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 54725
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 198335
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 54726
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 979468
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 54727
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 979464
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 54728
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 979471
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 54729
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 198188
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 54730
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 313134
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0