CMS Formulary

Displaying 231-240 of 1611142 results.
ID: 231
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 2057212
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 232
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 2057219
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 233
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 2099952
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 234
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 2105860
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 235
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 2469340
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 236
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 637188
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 336
Qty Limit Days: 365
ID: 237
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 795735
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 336
Qty Limit Days: 365
ID: 238
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 637190
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 336
Qty Limit Days: 365
ID: 239
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 795737
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 240
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 2284104
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 21
Qty Limit Days: 28