CMS Formulary

Displaying 88121-88130 of 1611142 results.
ID: 88121
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 197956
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 88122
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 197958
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 88123
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 200064
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 88124
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 199224
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 88125
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 313190
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 88126
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 198377
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 88127
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 198378
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 88128
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 1483744
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 88129
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 310346
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 88130
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 721791
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30