CMS Formulary

Displaying 57201-57210 of 1611142 results.
ID: 57201
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 308973
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57202
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 858824
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57203
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 858828
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57204
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 308976
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57205
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 834348
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57206
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 310379
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57207
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 310380
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57208
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1313112
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57209
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 855671
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57210
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 311679
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0