CMS Formulary

Displaying 58961-58970 of 1611142 results.
ID: 58961
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 905032
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 58962
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 1090996
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58963
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 197595
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58964
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 197596
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58965
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 309958
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58966
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 309960
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58967
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 884707
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 18
Qty Limit Days: 28
ID: 58968
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 753543
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 58969
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 2110455
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 58970
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 1314763
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0