CMS Formulary

Displaying 57681-57690 of 1611142 results.
ID: 57681
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1243229
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57682
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 616148
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57683
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 901614
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57684
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1147337
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57685
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1306298
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57686
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1551999
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 57687
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1484922
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 28
Qty Limit Days: 28
ID: 57688
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 2203999
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 28
Qty Limit Days: 28
ID: 57689
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 2204092
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 56
Qty Limit Days: 28
ID: 57690
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1544471
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30