CMS Formulary

Displaying 69641-69650 of 1611142 results.
ID: 69641
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 1482908
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69642
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 1806187
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 69643
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 1806189
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 69644
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 1806191
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 69645
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 1806193
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 69646
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 905369
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 69647
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 311166
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69648
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 197832
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69649
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 349196
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 69650
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 349197
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 300
Qty Limit Days: 30