CMS Formulary

Displaying 57821-57830 of 1611142 results.
ID: 57821
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1117522
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57822
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1664981
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57823
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 859871
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57824
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 204416
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57825
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1722934
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57826
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1807632
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57827
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1795609
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57828
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1795477
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57829
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 581531
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57830
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 2371050
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 150
Qty Limit Days: 30