CMS Formulary

Displaying 63971-63980 of 1611142 results.
ID: 63971
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 1658325
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 63972
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 1658329
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 63973
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 1658333
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 63974
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 1658337
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 63975
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 1658341
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 63976
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 1658345
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 63977
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 1602604
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28
ID: 63978
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 1602607
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28
ID: 63979
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 2274816
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 56
Qty Limit Days: 28
ID: 63980
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 2274814
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 56
Qty Limit Days: 28