CMS Formulary

Displaying 69111-69120 of 1611142 results.
ID: 69111
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 1299896
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69112
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 866090
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69113
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 643066
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69114
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 1652084
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69115
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 1006801
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 69116
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 996921
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 69117
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 721773
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 69118
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 476179
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 69119
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 476177
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 69120
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 199703
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0