CMS Formulary

Displaying 57971-57980 of 1611142 results.
ID: 57971
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 854984
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57972
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 854988
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57973
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 854925
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57974
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 904431
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 57975
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 312087
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57976
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 198334
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57977
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 198335
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57978
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 979468
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57979
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 979464
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 57980
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 979471
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0