CMS Formulary

Displaying 219411-219420 of 1611142 results.
ID: 219411
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 213272
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 219412
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 207100
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 219413
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 1307630
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 219414
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 1307635
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 219415
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 1243010
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 219416
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 1243014
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 219417
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 1601394
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 21
Qty Limit Days: 28
ID: 219418
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 1601386
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 21
Qty Limit Days: 28
ID: 219419
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 1601390
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 21
Qty Limit Days: 28
ID: 219420
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 1987734
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30