CMS Formulary

Displaying 58211-58220 of 1611142 results.
ID: 58211
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 312828
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 58212
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 312829
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 58213
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 312830
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 58214
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 312831
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 58215
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 312832
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 58216
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 314211
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 58217
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 199890
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58218
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 845488
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58219
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 861736
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 58220
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 861740
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30