CMS Formulary

Displaying 219421-219430 of 1611142 results.
ID: 219421
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 2058922
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 219422
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 2103175
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 219423
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 2103179
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 219424
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 810075
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 219425
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 810079
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 219426
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 2284108
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 21
Qty Limit Days: 28
ID: 219427
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 2057205
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 219428
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 2057216
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 219429
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 2057212
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 219430
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 2057219
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0