CMS Formulary

Displaying 57381-57390 of 1611142 results.
ID: 57381
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 861132
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 57382
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 310352
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57383
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 310353
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57384
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 200257
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 57385
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 200256
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 57386
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 200258
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 57387
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 313582
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57388
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 313584
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57389
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 314277
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57390
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 313586
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0