CMS Formulary

Displaying 57301-57310 of 1611142 results.
ID: 57301
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 213510
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57302
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 310386
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57303
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 199148
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57304
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 311787
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57305
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1605088
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57306
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 197511
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57307
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 309309
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57308
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 197512
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57309
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1373333
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57310
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1373335
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0