CMS Formulary

Displaying 63621-63630 of 1611142 results.
ID: 63621
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 706829
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 63622
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 706825
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 63623
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 858074
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 0
Qty Limit Days: 28
ID: 63624
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 858051
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 0
Qty Limit Days: 28
ID: 63625
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 858057
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 0
Qty Limit Days: 28
ID: 63626
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 858055
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28
ID: 63627
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 858053
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28
ID: 63628
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 2059017
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 63629
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 1232084
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 63630
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 1232088
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30