CMS Formulary

Displaying 65021-65030 of 1611142 results.
ID: 65021
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 1245268
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 112
Qty Limit Days: 28
ID: 65022
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 314088
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 65023
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 403914
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 65024
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 885209
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 65025
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 1922765
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 65026
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 1922763
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 65027
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 105553
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 65028
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 105590
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 65029
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 1364498
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 45
Qty Limit Days: 30
ID: 65030
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 1364490
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30