CMS Formulary

Displaying 58511-58520 of 1611142 results.
ID: 58511
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1487076
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 224
Qty Limit Days: 28
ID: 58512
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1368459
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58513
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 751970
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58514
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 836358
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 312
Qty Limit Days: 30
ID: 58515
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1191250
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58516
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 207373
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58517
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 1245268
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 112
Qty Limit Days: 28
ID: 58518
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 314088
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58519
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 403914
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58520
Formulary ID: 00021020
Formulary Version: 14
Contract Year: 2021
RXCUI: 885209
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0