CMS Formulary

Displaying 90891-90900 of 1611142 results.
ID: 90891
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 197409
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 90892
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 197408
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 90893
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 197405
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 90894
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 103401
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 90895
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 242736
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 90896
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 706546
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 90897
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 311033
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 40
Qty Limit Days: 28
ID: 90898
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 311027
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 40
Qty Limit Days: 28
ID: 90899
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 213442
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 40
Qty Limit Days: 28
ID: 90900
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 1860172
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 15
Qty Limit Days: 28