CMS Formulary

Displaying 208721-208730 of 1611142 results.
ID: 208721
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 855657
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 208722
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 1812011
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 208723
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 1812013
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 208724
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 562806
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 100
Qty Limit Days: 30
ID: 208725
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 825130
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 208726
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 260260
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 208727
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 311382
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 208728
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 1366550
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 208729
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 861668
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 8
Qty Limit Days: 28
ID: 208730
Formulary ID: 00021087
Formulary Version: 13
Contract Year: 2021
RXCUI: 830795
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0