CMS Formulary

Displaying 58431-58440 of 1611142 results.
ID: 58431
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 197557
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58432
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 903843
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58433
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1661799
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 58434
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1946589
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 32
Qty Limit Days: 30
ID: 58435
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1421461
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58436
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 2044928
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 58437
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 2044932
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 58438
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 2049884
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 58439
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 2045959
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 58440
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 2045961
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30