CMS Formulary

Displaying 225241-225250 of 1611142 results.
ID: 225241
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 897649
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 225242
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 349594
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 225243
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 349595
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 225244
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 608143
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 225245
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 608139
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 225246
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 897659
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 225247
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 897640
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 225248
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 855480
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 225249
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 855474
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 225250
Formulary ID: 00021097
Formulary Version: 13
Contract Year: 2021
RXCUI: 749860
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0