CMS Formulary

Displaying 62901-62910 of 1611142 results.
ID: 62901
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 206842
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 62902
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 198316
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 62903
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 359296
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 62904
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 308212
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 62905
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 403810
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 62906
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 403811
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 62907
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 1806195
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 62908
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 1806179
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 62909
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 1806183
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 62910
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 308191
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0