CMS Formulary

Displaying 59721-59730 of 1611142 results.
ID: 59721
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 1809667
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 59722
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 854228
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 18
Qty Limit Days: 30
ID: 59723
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 854235
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 24
Qty Limit Days: 30
ID: 59724
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 854238
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 36
Qty Limit Days: 30
ID: 59725
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 854241
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 48
Qty Limit Days: 30
ID: 59726
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 854248
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 59727
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 854245
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 48
Qty Limit Days: 30
ID: 59728
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 854252
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 59729
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 403890
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 59730
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 197549
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0