CMS Formulary

Displaying 215821-215830 of 1611142 results.
ID: 215821
Formulary ID: 00021094
Formulary Version: 13
Contract Year: 2021
RXCUI: 897783
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 215822
Formulary ID: 00021094
Formulary Version: 13
Contract Year: 2021
RXCUI: 897844
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 215823
Formulary ID: 00021094
Formulary Version: 13
Contract Year: 2021
RXCUI: 855480
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 215824
Formulary ID: 00021094
Formulary Version: 13
Contract Year: 2021
RXCUI: 855474
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 215825
Formulary ID: 00021094
Formulary Version: 13
Contract Year: 2021
RXCUI: 749860
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 215826
Formulary ID: 00021094
Formulary Version: 13
Contract Year: 2021
RXCUI: 198373
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 215827
Formulary ID: 00021094
Formulary Version: 13
Contract Year: 2021
RXCUI: 897853
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 215828
Formulary ID: 00021094
Formulary Version: 13
Contract Year: 2021
RXCUI: 859033
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 215829
Formulary ID: 00021094
Formulary Version: 13
Contract Year: 2021
RXCUI: 859040
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 215830
Formulary ID: 00021094
Formulary Version: 13
Contract Year: 2021
RXCUI: 859052
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0