CMS Formulary

Displaying 69861-69870 of 1611142 results.
ID: 69861
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 828755
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69862
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 828539
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69863
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 545835
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69864
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 645884
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69865
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 757968
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69866
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 754508
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 6
Qty Limit Days: 28
ID: 69867
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 197411
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69868
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 310600
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69869
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 403850
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69870
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 810090
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0