CMS Formulary

Displaying 221821-221830 of 1611142 results.
ID: 221821
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 861365
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 221822
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 861356
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 221823
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 1737244
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 221824
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 1737581
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 221825
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 2049891
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 221826
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 540617
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 20
Qty Limit Days: 10
ID: 221827
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 404419
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 30
ID: 221828
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 106351
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 221829
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 308136
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 221830
Formulary ID: 00021096
Formulary Version: 14
Contract Year: 2021
RXCUI: 197361
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0