CMS Formulary

Displaying 58001-58010 of 1611142 results.
ID: 58001
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 898342
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58002
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 898346
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58003
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 863669
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58004
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 313581
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 58005
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 402246
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58006
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 402247
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58007
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 664741
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58008
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 833528
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58009
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 722134
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58010
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 722137
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0