CMS Formulary

Displaying 214621-214630 of 1611142 results.
ID: 214621
Formulary ID: 00021094
Formulary Version: 13
Contract Year: 2021
RXCUI: 748962
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 214622
Formulary ID: 00021094
Formulary Version: 13
Contract Year: 2021
RXCUI: 831533
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 214623
Formulary ID: 00021094
Formulary Version: 13
Contract Year: 2021
RXCUI: 1359134
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 214624
Formulary ID: 00021094
Formulary Version: 13
Contract Year: 2021
RXCUI: 312138
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 214625
Formulary ID: 00021094
Formulary Version: 13
Contract Year: 2021
RXCUI: 312839
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 36
Qty Limit Days: 28
ID: 214626
Formulary ID: 00021094
Formulary Version: 13
Contract Year: 2021
RXCUI: 312837
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 36
Qty Limit Days: 28
ID: 214627
Formulary ID: 00021094
Formulary Version: 13
Contract Year: 2021
RXCUI: 1359127
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 214628
Formulary ID: 00021094
Formulary Version: 13
Contract Year: 2021
RXCUI: 1091341
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 214629
Formulary ID: 00021094
Formulary Version: 13
Contract Year: 2021
RXCUI: 1359124
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 214630
Formulary ID: 00021094
Formulary Version: 13
Contract Year: 2021
RXCUI: 403884
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0