CMS Formulary

Displaying 63251-63260 of 1611142 results.
ID: 63251
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 351285
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 63252
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 2123194
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 63253
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 313565
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 63254
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 313564
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 63255
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 199885
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 63256
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 242438
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 63257
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 200094
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 63258
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 200095
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 63259
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 200096
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 63260
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 197311
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0