CMS Formulary

Displaying 219721-219730 of 1611142 results.
ID: 219721
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 310273
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 219722
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 284245
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 219723
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 835886
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 219724
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 866049
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 219725
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 896019
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 219726
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 896027
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 219727
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 896023
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 219728
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 213484
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 219729
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 759473
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 180
ID: 219730
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 859088
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 36
Qty Limit Days: 30