CMS Formulary

Displaying 224041-224050 of 1611142 results.
ID: 224041
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 197305
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 224042
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 313786
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 224043
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 1312408
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 84
Qty Limit Days: 28
ID: 224044
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 1439894
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 224045
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 1439896
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 224046
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 1439899
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 224047
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 1439901
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 224048
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 1439903
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 224049
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 2105657
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 224050
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 2105645
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30