CMS Formulary

Displaying 223381-223390 of 1611142 results.
ID: 223381
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 854235
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 11
Qty Limit Days: 28
ID: 223382
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 854238
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 16
Qty Limit Days: 28
ID: 223383
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 854241
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 22
Qty Limit Days: 28
ID: 223384
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 854248
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 28
Qty Limit Days: 28
ID: 223385
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 854245
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 22
Qty Limit Days: 28
ID: 223386
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 854252
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 28
Qty Limit Days: 28
ID: 223387
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 406503
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 223388
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 858262
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 223389
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 310023
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 223390
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 403890
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0