CMS Formulary

Displaying 57881-57890 of 1611142 results.
ID: 57881
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 205290
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57882
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 315134
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57883
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 866021
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57884
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1992303
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57885
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 427163
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57886
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 2399892
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 8
Qty Limit Days: 28
ID: 57887
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 2399895
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 8
Qty Limit Days: 28
ID: 57888
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 2399898
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 8
Qty Limit Days: 28
ID: 57889
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 2399901
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 8
Qty Limit Days: 28
ID: 57890
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 198013
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0