CMS Formulary

Displaying 58281-58290 of 1611142 results.
ID: 58281
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 857216
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58282
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 857224
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58283
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 314266
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 100
Qty Limit Days: 30
ID: 58284
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 749784
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58285
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 644088
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28
ID: 58286
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1603861
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 91
Qty Limit Days: 84
ID: 58287
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1251336
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58288
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 749157
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58289
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 748798
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58290
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1989507
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0