CMS Formulary

Displaying 226221-226230 of 1611142 results.
ID: 226221
Formulary ID: 00021098
Formulary Version: 10
Contract Year: 2021
RXCUI: 847913
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 30
ID: 226222
Formulary ID: 00021098
Formulary Version: 10
Contract Year: 2021
RXCUI: 1990869
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 226223
Formulary ID: 00021098
Formulary Version: 10
Contract Year: 2021
RXCUI: 861045
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 6
Qty Limit Days: 30
ID: 226224
Formulary ID: 00021098
Formulary Version: 10
Contract Year: 2021
RXCUI: 861043
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 10
Qty Limit Days: 30
ID: 226225
Formulary ID: 00021098
Formulary Version: 10
Contract Year: 2021
RXCUI: 206347
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 226226
Formulary ID: 00021098
Formulary Version: 10
Contract Year: 2021
RXCUI: 1729511
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 226227
Formulary ID: 00021098
Formulary Version: 10
Contract Year: 2021
RXCUI: 1085773
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 454
Qty Limit Days: 30
ID: 226228
Formulary ID: 00021098
Formulary Version: 10
Contract Year: 2021
RXCUI: 1648999
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 454
Qty Limit Days: 30
ID: 226229
Formulary ID: 00021098
Formulary Version: 10
Contract Year: 2021
RXCUI: 486515
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 226230
Formulary ID: 00021098
Formulary Version: 10
Contract Year: 2021
RXCUI: 730782
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0