CMS Formulary

Displaying 218991-219000 of 1611142 results.
ID: 218991
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 1111642
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 218992
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 1487363
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 12
Qty Limit Days: 28
ID: 218993
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 308725
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 218994
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 855657
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 218995
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 1812011
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 218996
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 1812013
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 218997
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 825130
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 218998
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 885131
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 218999
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 260260
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 219000
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 1370758
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0