CMS Formulary

Displaying 90921-90930 of 1611142 results.
ID: 90921
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 847348
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 90922
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 847245
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 90923
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 197590
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 90924
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 197591
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 90925
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 197589
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 90926
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 197391
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 90927
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 197392
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 90928
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 597852
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 90929
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 597850
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 90930
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 310273
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0