CMS Formulary

Displaying 223281-223290 of 1611142 results.
ID: 223281
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 991082
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 223282
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 702519
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 1500
Qty Limit Days: 30
ID: 223283
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 314182
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 223284
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 885219
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 223285
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 885213
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 223286
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 1049635
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 30
ID: 223287
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 198086
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 223288
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 199167
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 223289
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 199164
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 223290
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 763181
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0