CMS Formulary

Displaying 209161-209170 of 1611142 results.
ID: 209161
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 2057205
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 209162
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 2057216
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 209163
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 2057212
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 209164
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 2057219
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 209165
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 2099952
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 209166
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 2105860
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 209167
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 2469340
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 209168
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 637188
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 209169
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 795735
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 209170
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 637190
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0