CMS Formulary

Displaying 196821-196830 of 1611142 results.
ID: 196821
Formulary ID: 00021083
Formulary Version: 17
Contract Year: 2021
RXCUI: 389242
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 196822
Formulary ID: 00021083
Formulary Version: 17
Contract Year: 2021
RXCUI: 1246673
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 196823
Formulary ID: 00021083
Formulary Version: 17
Contract Year: 2021
RXCUI: 204119
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 196824
Formulary ID: 00021083
Formulary Version: 17
Contract Year: 2021
RXCUI: 728126
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 196825
Formulary ID: 00021083
Formulary Version: 17
Contract Year: 2021
RXCUI: 1741905
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 196826
Formulary ID: 00021083
Formulary Version: 17
Contract Year: 2021
RXCUI: 2287905
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28
ID: 196827
Formulary ID: 00021083
Formulary Version: 17
Contract Year: 2021
RXCUI: 2056700
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28
ID: 196828
Formulary ID: 00021083
Formulary Version: 17
Contract Year: 2021
RXCUI: 1359020
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 196829
Formulary ID: 00021083
Formulary Version: 17
Contract Year: 2021
RXCUI: 1358775
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 196830
Formulary ID: 00021083
Formulary Version: 17
Contract Year: 2021
RXCUI: 751884
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0