CMS Formulary

Displaying 222271-222280 of 1611142 results.
ID: 222271
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 1145932
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 222272
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 1799230
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 222273
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 1925255
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28
ID: 222274
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 1925257
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 222275
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 1598989
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 222276
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 1601660
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 222277
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 1992428
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 222278
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 213282
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 222279
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 213283
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 222280
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 213284
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0