CMS Formulary

Displaying 54761-54770 of 1611142 results.
ID: 54761
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 860715
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 54762
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 860695
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 54763
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 860707
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 54764
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 1800499
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 54765
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 1800500
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 54766
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 992150
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 54767
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 724863
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 54768
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 724859
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 54769
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 724861
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 54770
Formulary ID: 00021018
Formulary Version: 14
Contract Year: 2021
RXCUI: 403818
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0