CMS Formulary

Displaying 64091-64100 of 1611142 results.
ID: 64091
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 197627
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 64092
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 197628
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 64093
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 199390
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 64094
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 197553
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 64095
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 328160
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 64096
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 310490
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 64097
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 310488
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 64098
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 993687
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 64099
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 993691
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 64100
Formulary ID: 00021022
Formulary Version: 14
Contract Year: 2021
RXCUI: 903887
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0