CMS Formulary

Displaying 58721-58730 of 1611142 results.
ID: 58721
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 309843
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 1200
Qty Limit Days: 30
ID: 58722
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 1190568
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58723
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 1797907
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 16
Qty Limit Days: 30
ID: 58724
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 197730
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58725
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 197731
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58726
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 864761
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 1200
Qty Limit Days: 30
ID: 58727
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 864769
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 600
Qty Limit Days: 30
ID: 58728
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 315187
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58729
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 856724
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58730
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 856733
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0