CMS Formulary

Displaying 5761-5770 of 1611142 results.
ID: 5761
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1921228
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 5762
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1988772
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 5763
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1988786
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5764
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1723763
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 3
Qty Limit Days: 28
ID: 5765
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1723767
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 3
Qty Limit Days: 28
ID: 5766
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1723772
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 3
Qty Limit Days: 28
ID: 5767
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1726639
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 5768
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1364362
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 5769
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1364358
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 5770
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2473042
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30