CMS Formulary

Displaying 99581-99590 of 1611142 results.
ID: 99581
Formulary ID: 00021038
Formulary Version: 14
Contract Year: 2021
RXCUI: 858074
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 0
Qty Limit Days: 28
ID: 99582
Formulary ID: 00021038
Formulary Version: 14
Contract Year: 2021
RXCUI: 858051
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 0
Qty Limit Days: 28
ID: 99583
Formulary ID: 00021038
Formulary Version: 14
Contract Year: 2021
RXCUI: 858057
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 0
Qty Limit Days: 28
ID: 99584
Formulary ID: 00021038
Formulary Version: 14
Contract Year: 2021
RXCUI: 858055
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28
ID: 99585
Formulary ID: 00021038
Formulary Version: 14
Contract Year: 2021
RXCUI: 858053
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28
ID: 99586
Formulary ID: 00021038
Formulary Version: 14
Contract Year: 2021
RXCUI: 2059017
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 99587
Formulary ID: 00021038
Formulary Version: 14
Contract Year: 2021
RXCUI: 1232084
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 99588
Formulary ID: 00021038
Formulary Version: 14
Contract Year: 2021
RXCUI: 1232088
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 99589
Formulary ID: 00021038
Formulary Version: 14
Contract Year: 2021
RXCUI: 1114202
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 99590
Formulary ID: 00021038
Formulary Version: 14
Contract Year: 2021
RXCUI: 1549683
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0