CMS Formulary

Displaying 57611-57620 of 1611142 results.
ID: 57611
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 617312
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57612
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 617310
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57613
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 617311
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57614
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 310818
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57615
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 259255
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57616
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 905028
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28
ID: 57617
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 905024
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 57618
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 577208
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 57619
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 205328
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57620
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 314155
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30