CMS Formulary

Displaying 58051-58060 of 1611142 results.
ID: 58051
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 861650
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 58052
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 861654
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 58053
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 2123076
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 36
Qty Limit Days: 30
ID: 58054
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 349591
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 58055
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 349592
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 58056
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 349593
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 58057
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1011736
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58058
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1011739
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58059
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 388311
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58060
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 200133
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0