CMS Formulary

Displaying 57751-57760 of 1611142 results.
ID: 57751
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 686400
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57752
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1190572
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57753
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 686418
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57754
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 835829
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57755
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 860975
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 57756
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 860981
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 57757
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 312136
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57758
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 312137
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57759
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1299911
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57760
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 855861
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0