CMS Formulary

Displaying 57951-57960 of 1611142 results.
ID: 57951
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 309076
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57952
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 309078
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57953
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 198352
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57954
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 200031
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57955
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 200033
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57956
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 315223
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 18
Qty Limit Days: 30
ID: 57957
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 313161
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 18
Qty Limit Days: 30
ID: 57958
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 313160
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 9
Qty Limit Days: 30
ID: 57959
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 854873
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 57960
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 198052
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0