CMS Formulary

Displaying 58771-58780 of 1611142 results.
ID: 58771
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 2469340
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58772
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 637188
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 336
Qty Limit Days: 365
ID: 58773
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 795735
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 336
Qty Limit Days: 365
ID: 58774
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 637190
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 336
Qty Limit Days: 365
ID: 58775
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 795737
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58776
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 2284104
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 21
Qty Limit Days: 28
ID: 58777
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 1741049
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58778
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 2273115
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58779
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 616283
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 58780
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 2284106
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 21
Qty Limit Days: 28