CMS Formulary

Displaying 57491-57500 of 1611142 results.
ID: 57491
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 643714
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 28
Qty Limit Days: 28
ID: 57492
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1429367
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 28
Qty Limit Days: 28
ID: 57493
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 643722
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 28
Qty Limit Days: 28
ID: 57494
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1369724
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 21
Qty Limit Days: 28
ID: 57495
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1369728
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 21
Qty Limit Days: 28
ID: 57496
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1369732
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 21
Qty Limit Days: 28
ID: 57497
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1369736
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 21
Qty Limit Days: 28
ID: 57498
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1940376
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 57499
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1940372
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 57500
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 2197501
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30