CMS Formulary

Displaying 222501-222510 of 1611142 results.
ID: 222501
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 2166143
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28
ID: 222502
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 2196900
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 222503
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 1873087
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 3
Qty Limit Days: 180
ID: 222504
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 1940709
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 84
Qty Limit Days: 28
ID: 222505
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 835896
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 222506
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 835835
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 222507
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 1115468
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 222508
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 1926069
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 222509
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 1115259
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 222510
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 1115459
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0