CMS Formulary

Displaying 58661-58670 of 1611142 results.
ID: 58661
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 1859000
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 58662
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 1604544
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 13
Qty Limit Days: 28
ID: 58663
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 2002420
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 18
Qty Limit Days: 28
ID: 58664
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 1923338
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58665
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 1923347
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58666
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 1876406
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58667
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 2375329
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58668
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 2099302
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58669
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 2003757
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58670
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 2003767
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0