CMS Formulary

Displaying 55751-55760 of 1611142 results.
ID: 55751
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 904467
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 55752
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 904475
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 55753
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1490065
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 55754
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 199058
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 55755
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 596843
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 55756
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 308868
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 55757
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 403879
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 55758
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 476556
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 55759
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 197535
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 270
Qty Limit Days: 30
ID: 55760
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 310295
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30