CMS Formulary

Displaying 55831-55840 of 1611142 results.
ID: 55831
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 197409
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 55832
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 197408
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 55833
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 197405
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 55834
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 103401
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 55835
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 242736
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 55836
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 706546
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 55837
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 311033
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 40
Qty Limit Days: 28
ID: 55838
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 311027
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 40
Qty Limit Days: 28
ID: 55839
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 213442
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 40
Qty Limit Days: 28
ID: 55840
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1860172
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 15
Qty Limit Days: 28