CMS Formulary

Displaying 208701-208710 of 1611142 results.
ID: 208701
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 864681
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 208702
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 864675
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 208703
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 835726
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 208704
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 349373
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 208705
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 857216
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 208706
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 857224
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 208707
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 861512
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 125
Qty Limit Days: 28
ID: 208708
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 197572
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 208709
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 314266
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 100
Qty Limit Days: 30
ID: 208710
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 749784
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0