CMS Formulary

Displaying 219791-219800 of 1611142 results.
ID: 219791
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 198071
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 219792
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 197541
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 219793
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 753478
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 219794
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 753479
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 219795
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 1091828
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 219796
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 351173
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 219797
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 351174
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 219798
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 351175
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 219799
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 204520
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 219800
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 1601982
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0