CMS Formulary

Displaying 5701-5710 of 1611142 results.
ID: 5701
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 205322
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 5702
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 205323
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 5703
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 403853
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5704
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 403854
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5705
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 403855
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5706
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 859981
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 5707
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 859975
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 5708
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 849389
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5709
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 313407
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5710
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 313408
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0