CMS Formulary

Displaying 208391-208400 of 1611142 results.
ID: 208391
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 863669
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 208392
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 313581
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 208393
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 402246
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 208394
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 402247
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 208395
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 664741
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 208396
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 833528
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 208397
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 722134
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 208398
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 722137
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 208399
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 722126
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 208400
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 722131
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0