CMS Formulary

Displaying 55351-55360 of 1611142 results.
ID: 55351
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1729311
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 6
Qty Limit Days: 28
ID: 55352
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 2055766
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 55353
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1734642
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 55354
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1988671
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 28
Qty Limit Days: 28
ID: 55355
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1988675
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 28
Qty Limit Days: 28
ID: 55356
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1924315
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 55357
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1486841
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 55358
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 798300
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 55359
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 830253
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 55360
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 830245
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0