CMS Formulary

Displaying 219431-219440 of 1611142 results.
ID: 219431
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 2099952
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 219432
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 2105860
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 219433
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 637188
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 219434
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 795735
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 219435
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 637190
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 219436
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 795737
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 219437
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 2284104
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 21
Qty Limit Days: 28
ID: 219438
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 1741049
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 219439
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 2273115
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 219440
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 616283
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30