CMS Formulary

Displaying 5621-5630 of 1611142 results.
ID: 5621
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1605075
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5622
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 314072
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 25
ID: 5623
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 244967
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5624
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 309680
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5625
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 309679
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5626
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1376336
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5627
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 204874
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5628
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 313415
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5629
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1006120
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5630
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2260709
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0