CMS Formulary

Displaying 215681-215690 of 1611142 results.
ID: 215681
Formulary ID: 00021094
Formulary Version: 13
Contract Year: 2021
RXCUI: 309113
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 215682
Formulary ID: 00021094
Formulary Version: 13
Contract Year: 2021
RXCUI: 200345
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 215683
Formulary ID: 00021094
Formulary Version: 13
Contract Year: 2021
RXCUI: 197903
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 215684
Formulary ID: 00021094
Formulary Version: 13
Contract Year: 2021
RXCUI: 197904
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 215685
Formulary ID: 00021094
Formulary Version: 13
Contract Year: 2021
RXCUI: 197905
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 215686
Formulary ID: 00021094
Formulary Version: 13
Contract Year: 2021
RXCUI: 311353
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 215687
Formulary ID: 00021094
Formulary Version: 13
Contract Year: 2021
RXCUI: 311354
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 215688
Formulary ID: 00021094
Formulary Version: 13
Contract Year: 2021
RXCUI: 197884
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 215689
Formulary ID: 00021094
Formulary Version: 13
Contract Year: 2021
RXCUI: 197885
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 215690
Formulary ID: 00021094
Formulary Version: 13
Contract Year: 2021
RXCUI: 197886
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0