CMS Formulary

Displaying 58361-58370 of 1611142 results.
ID: 58361
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 309307
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58362
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1790684
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58363
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 310003
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58364
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 310004
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58365
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 310005
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58366
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1099681
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58367
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 197682
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58368
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 866910
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58369
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 308867
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58370
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1092357
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0