CMS Formulary

Displaying 5871-5880 of 1611142 results.
ID: 5871
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 259081
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 5872
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 835603
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 5873
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 283536
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5874
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 199387
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 480
Qty Limit Days: 30
ID: 5875
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 308429
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5876
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 283523
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 2160
Qty Limit Days: 30
ID: 5877
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 197745
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5878
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 197746
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5879
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 198358
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 5880
Formulary ID: 00021001
Formulary Version: 14
Contract Year: 2021
RXCUI: 1099569
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0