CMS Formulary

Displaying 209081-209090 of 1611142 results.
ID: 209081
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 205739
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 209082
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 352228
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 209083
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 1653579
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 209084
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 198148
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 209085
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 1797833
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 209086
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 1797844
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 209087
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 393245
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 209088
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 885857
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 209089
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 860901
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 209090
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 351265
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0