CMS Formulary

Displaying 69321-69330 of 1611142 results.
ID: 69321
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 197445
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69322
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 197816
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69323
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 197815
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69324
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 1001004
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69325
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 351264
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 69326
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 904605
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69327
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 904571
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69328
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 904583
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69329
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 904593
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69330
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 848951
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0