CMS Formulary

Displaying 69301-69310 of 1611142 results.
ID: 69301
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 852877
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69302
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 197979
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69303
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 197978
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69304
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 1246306
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 69305
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 1246290
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 69306
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 1666334
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69307
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 1116639
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69308
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 1872261
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69309
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 2055008
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69310
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 991233
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0