CMS Formulary

Displaying 58411-58420 of 1611142 results.
ID: 58411
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1020155
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 91
Qty Limit Days: 84
ID: 58412
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1720616
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58413
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1369737
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58414
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1722676
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58415
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1369770
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58416
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1941470
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58417
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1941476
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58418
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1941473
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58419
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 197698
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58420
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 856783
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0