CMS Formulary

Displaying 90641-90650 of 1611142 results.
ID: 90641
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 1310138
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 112
Qty Limit Days: 28
ID: 90642
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 1310144
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 112
Qty Limit Days: 28
ID: 90643
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 1310147
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 112
Qty Limit Days: 28
ID: 90644
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 1364114
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 90645
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 1364118
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 90646
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 1364122
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 90647
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 1653243
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 90648
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 1599797
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 90649
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 1603361
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 90650
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 1603365
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0