CMS Formulary

Displaying 55331-55340 of 1611142 results.
ID: 55331
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 352297
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 55332
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 731328
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 55333
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 404460
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 55334
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1593140
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 55335
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1547575
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 55336
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1547110
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 55337
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1243848
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 55338
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1243843
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 55339
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1243833
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 55340
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 665044
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30