CMS Formulary

Displaying 69441-69450 of 1611142 results.
ID: 69441
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 199903
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69442
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 998671
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 69443
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 998675
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 69444
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 998679
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 8
Qty Limit Days: 28
ID: 69445
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 1000048
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69446
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 876524
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69447
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 876514
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69448
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 876529
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69449
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 876519
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69450
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 312593
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0