CMS Formulary

Displaying 63801-63810 of 1611142 results.
ID: 63801
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 2099691
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 63802
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 2099697
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 63803
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 1313785
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 63804
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 207588
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 63805
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 213510
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 63806
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 310386
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 63807
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 199148
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 63808
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 311787
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 63809
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 1605088
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 63810
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 197511
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0