CMS Formulary

Displaying 5721-5730 of 1611142 results.
ID: 5721
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 686418
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5722
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 835829
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5723
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 860975
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 5724
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 860981
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 5725
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 312136
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5726
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 312137
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5727
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1299911
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5728
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 855861
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5729
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 197890
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5730
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 855873
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0