CMS Formulary

Displaying 65201-65210 of 1611142 results.
ID: 65201
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 351267
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 65202
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 905172
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 65203
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 905168
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 65204
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 892589
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 700
Qty Limit Days: 30
ID: 65205
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 894780
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 300
Qty Limit Days: 30
ID: 65206
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 997287
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 65207
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 997296
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 65208
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 310792
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 65209
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 310793
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 65210
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 835589
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0