CMS Formulary

Displaying 223251-223260 of 1611142 results.
ID: 223251
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 603378
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 223252
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 1190225
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 8
Qty Limit Days: 30
ID: 223253
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 836368
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 25
Qty Limit Days: 30
ID: 223254
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 1430453
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 223255
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 1430457
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 223256
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 1100706
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 223257
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 1430449
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 223258
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 1592748
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 223259
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 1592752
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 223260
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 1243033
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30