CMS Formulary

Displaying 69191-69200 of 1611142 results.
ID: 69191
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 810002
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 69192
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 809990
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 69193
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 809994
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 69194
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 809998
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 69195
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 995156
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1200
Qty Limit Days: 30
ID: 69196
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 308963
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69197
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 317173
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69198
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 308964
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69199
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 197604
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 69200
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 197606
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0