CMS Formulary

Displaying 65371-65380 of 1611142 results.
ID: 65371
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 867506
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 65372
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 1425230
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 65373
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 1425228
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 65374
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 1245003
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 65375
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 825425
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 65376
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 825429
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 65377
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 884619
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 65378
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 2121061
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 84
Qty Limit Days: 28
ID: 65379
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 1656356
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 65380
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 1859501
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30