CMS Formulary

Displaying 571-580 of 1611142 results.
ID: 571
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 2200658
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 572
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 2200650
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 573
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 1653204
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 28
ID: 574
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 351926
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 40
Qty Limit Days: 28
ID: 575
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 849851
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 576
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 847247
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 577
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 847348
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 578
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 847245
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 579
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 197590
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 580
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 197591
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30