CMS Formulary

Displaying 58311-58320 of 1611142 results.
ID: 58311
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 830801
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58312
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 352257
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 540
Qty Limit Days: 30
ID: 58313
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 2393794
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 540
Qty Limit Days: 30
ID: 58314
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 2121764
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 58315
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 2173841
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 58316
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1364477
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58317
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1602028
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 58318
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1602034
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 58319
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1602040
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 58320
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1602046
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28