CMS Formulary

Displaying 59791-59800 of 1611142 results.
ID: 59791
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 858625
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 59792
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 855182
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 59793
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 855189
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 59794
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 602964
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 59795
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 402131
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 59796
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 349545
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 59797
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 349490
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 59798
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 349553
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 59799
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 349547
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 59800
Formulary ID: 00021021
Formulary Version: 14
Contract Year: 2021
RXCUI: 856373
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0