CMS Formulary

Displaying 57061-57070 of 1611142 results.
ID: 57061
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 749780
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57062
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 204844
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57063
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 198372
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57064
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 198369
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57065
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 198370
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57066
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1242819
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 3
Qty Limit Days: 56
ID: 57067
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1242815
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 56
ID: 57068
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 616749
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57069
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 728231
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57070
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1657212
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0