CMS Formulary

Displaying 69721-69730 of 1611142 results.
ID: 69721
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 314075
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69722
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 310812
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69723
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 861427
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69724
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 197653
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 69725
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 991086
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69726
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 314006
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 69727
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 315107
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 69728
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 310489
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 69729
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 250344
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69730
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 722122
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30