CMS Formulary

Displaying 209441-209450 of 1611142 results.
ID: 209441
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 351133
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 209442
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 313979
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 209443
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 834127
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 209444
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 141935
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 209445
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 849385
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 209446
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 861848
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 209447
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 859835
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 209448
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 1099687
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 209449
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 312036
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 209450
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 856940
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 5550
Qty Limit Days: 30