CMS Formulary

Displaying 206691-206700 of 1611142 results.
ID: 206691
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 672567
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 206692
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 672569
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 206693
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 672571
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 206694
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 993541
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 206695
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 993557
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 206696
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 996097
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 206697
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 996615
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 206698
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 996594
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 206699
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 996603
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 206700
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 996609
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0