CMS Formulary

Displaying 216591-216600 of 1611142 results.
ID: 216591
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 859835
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 216592
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 1099687
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 216593
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 312036
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 216594
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 856940
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 5550
Qty Limit Days: 30
ID: 216595
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 834137
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 216596
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 810002
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 216597
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 809990
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 216598
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 809994
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 216599
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 809998
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 216600
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 995156
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 1200
Qty Limit Days: 30