CMS Formulary

Displaying 209361-209370 of 1611142 results.
ID: 209361
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 861960
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 209362
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 905032
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 209363
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 1090996
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 209364
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 197595
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 209365
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 197596
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 209366
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 884707
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 209367
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 753543
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 209368
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 2110455
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 209369
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 904870
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 209370
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 904876
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28