CMS Formulary

Displaying 217811-217820 of 1611142 results.
ID: 217811
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 1727485
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 217812
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 1242998
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 217813
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 2058950
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28
ID: 217814
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 2058946
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 217815
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 1722376
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 63
Qty Limit Days: 28
ID: 217816
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 312614
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 217817
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 283077
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 217818
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 993755
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4500
Qty Limit Days: 30
ID: 217819
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 197448
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 217820
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 1923432
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0