CMS Formulary

Displaying 216891-216900 of 1611142 results.
ID: 216891
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 197696
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 10
Qty Limit Days: 30
ID: 216892
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 1870650
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 216893
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 829762
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 216894
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 1191234
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 216895
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 1658637
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 216896
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 307718
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 216897
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 307719
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 216898
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 831430
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 216899
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 1807516
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 216900
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 1665210
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0