CMS Formulary

Displaying 88711-88720 of 1611142 results.
ID: 88711
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 2058946
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 88712
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 1722376
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 63
Qty Limit Days: 28
ID: 88713
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 2100099
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 180
ID: 88714
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 2100100
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 180
ID: 88715
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 312614
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 88716
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 283077
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 88717
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 993755
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 4500
Qty Limit Days: 30
ID: 88718
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 197448
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 88719
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 1923432
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 88720
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 578018
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0