CMS Formulary

Displaying 65701-65710 of 1611142 results.
ID: 65701
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 308048
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 65702
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 197321
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 65703
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 197322
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 150
Qty Limit Days: 30
ID: 65704
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 198057
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 65705
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 312134
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 65706
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 198059
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 65707
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 198033
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 65708
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 197444
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 65709
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 197445
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 65710
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 197816
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0