CMS Formulary

Displaying 58621-58630 of 1611142 results.
ID: 58621
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 1658102
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58622
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 798451
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58623
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 830263
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58624
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 1658150
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58625
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 2055815
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58626
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 1441740
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58627
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 835721
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58628
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 1046920
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 1008
Qty Limit Days: 90
ID: 58629
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 404457
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58630
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 404458
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0