CMS Formulary

Displaying 58651-58660 of 1611142 results.
ID: 58651
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 1595292
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58652
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 1995479
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58653
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 1595457
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58654
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 2268231
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 16
Qty Limit Days: 30
ID: 58655
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 2268227
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 16
Qty Limit Days: 30
ID: 58656
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 402092
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 58657
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 861637
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58658
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 861206
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58659
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 904170
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58660
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 854859
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0