CMS Formulary

Displaying 66161-66170 of 1611142 results.
ID: 66161
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 836368
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 25
Qty Limit Days: 28
ID: 66162
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 1552004
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 30
ID: 66163
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 1723478
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 66164
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 1430453
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 66165
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 1430457
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 66166
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 1100706
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 66167
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 1430449
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 66168
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 1592748
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 66169
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 1592752
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 66170
Formulary ID: 00021024
Formulary Version: 14
Contract Year: 2021
RXCUI: 1243033
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30