CMS Formulary

Displaying 57651-57660 of 1611142 results.
ID: 57651
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 978573
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57652
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1605071
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57653
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1605075
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57654
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 314072
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 25
ID: 57655
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 244967
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57656
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 309680
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57657
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 309679
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57658
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1376336
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57659
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 204874
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57660
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 313415
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0