CMS Formulary

Displaying 207491-207500 of 1611142 results.
ID: 207491
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 861448
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 28
ID: 207492
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 309370
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 28
ID: 207493
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 103457
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 207494
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 197407
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 207495
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 310364
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 207496
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 238920
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 207497
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 349351
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 207498
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 204135
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 207499
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 861487
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 100
Qty Limit Days: 28
ID: 207500
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 1992281
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 28