CMS Formulary

Displaying 57291-57300 of 1611142 results.
ID: 57291
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 198222
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57292
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 198150
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57293
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 96304
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57294
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 998689
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57295
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 998685
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57296
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 2099686
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 57297
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 2099691
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 57298
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 2099697
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 57299
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1313785
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57300
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 207588
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0