CMS Formulary

Displaying 64251-64260 of 1611142 results.
ID: 64251
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 861430
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 64252
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 886662
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 64253
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 886666
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 64254
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 886671
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 64255
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 686400
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 64256
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 1190572
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 64257
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 686418
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 64258
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 835829
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 64259
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 860975
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 64260
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 860981
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30