CMS Formulary

Displaying 208101-208110 of 1611142 results.
ID: 208101
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 205285
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 208102
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 643019
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 208103
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 643022
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 208104
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 866482
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 208105
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 866479
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 208106
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 349401
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 208107
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 349405
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 208108
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 205322
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 208109
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 205323
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 208110
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 403853
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0