CMS Formulary

Displaying 55731-55740 of 1611142 results.
ID: 55731
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1006801
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 55732
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 996921
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 55733
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 721773
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 55734
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 476179
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 55735
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 476177
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 55736
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 199703
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 55737
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1359129
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 55738
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 485440
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 55739
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1860157
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 55740
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1860129
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30