CMS Formulary

Displaying 63471-63480 of 1611142 results.
ID: 63471
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 1307061
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 63472
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 1115698
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 540
Qty Limit Days: 180
ID: 63473
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 1308569
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 63474
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 351209
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 63475
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 197623
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 63476
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 2055650
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 63477
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 1099808
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 63478
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 1484296
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 63479
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 1190919
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 63480
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 1244205
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0