CMS Formulary

Displaying 57111-57120 of 1611142 results.
ID: 57111
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 2180336
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 57112
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 615979
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 57113
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 207059
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 15
Qty Limit Days: 30
ID: 57114
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 211140
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 57115
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 706831
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 57116
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 706827
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 57117
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 706829
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 57118
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 706825
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 57119
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 858074
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 0
Qty Limit Days: 28
ID: 57120
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 858051
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 0
Qty Limit Days: 28