CMS Formulary

Displaying 57901-57910 of 1611142 results.
ID: 57901
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 857328
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57902
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 857340
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57903
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 259081
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 57904
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 835603
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 57905
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 283536
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57906
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 199387
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 480
Qty Limit Days: 30
ID: 57907
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 308429
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57908
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 283523
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 2160
Qty Limit Days: 30
ID: 57909
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 197745
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57910
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 197746
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0