CMS Formulary

Displaying 55801-55810 of 1611142 results.
ID: 55801
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 856940
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 2700
Qty Limit Days: 30
ID: 55802
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 834137
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 55803
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 810002
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 55804
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 809990
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 55805
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 809994
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 55806
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 809998
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 55807
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 995156
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1200
Qty Limit Days: 30
ID: 55808
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 308963
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 55809
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 317173
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 55810
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 308964
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0