CMS Formulary

Displaying 5791-5800 of 1611142 results.
ID: 5791
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 859871
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5792
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 204416
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5793
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1722934
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5794
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1807632
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5795
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1795609
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5796
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1795477
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5797
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 581531
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5798
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2371050
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 150
Qty Limit Days: 30
ID: 5799
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2371054
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 150
Qty Limit Days: 30
ID: 5800
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 2371058
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 150
Qty Limit Days: 30