CMS Formulary

Displaying 212071-212080 of 1611142 results.
ID: 212071
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 979092
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 212072
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 1738483
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 212073
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 1738495
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 212074
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 1738503
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 212075
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 1099596
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 212076
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 197412
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 212077
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 312828
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 212078
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 312829
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 212079
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 312830
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 212080
Formulary ID: 00021091
Formulary Version: 13
Contract Year: 2021
RXCUI: 312831
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30