CMS Formulary

Displaying 220721-220730 of 1611142 results.
ID: 220721
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 105292
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 220722
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 199592
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 220723
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 483090
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 220724
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 476399
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 220725
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 476515
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 220726
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 805464
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 220727
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 1659927
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 220728
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 403878
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 220729
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 1098143
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 220730
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 2200174
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30