CMS Formulary

Displaying 220421-220430 of 1611142 results.
ID: 220421
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 197770
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 220422
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 485023
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 220423
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 309362
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 220424
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 198223
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 220425
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 485020
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 220426
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 856364
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 220427
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 863636
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 220428
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 863619
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 220429
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 863628
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 220430
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 545236
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0