CMS Formulary

Displaying 91001-91010 of 1611142 results.
ID: 91001
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 904593
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 91002
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 848951
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 91003
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 835958
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 91004
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 834346
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 91005
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 993466
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 91006
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 993470
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 91007
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 993462
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 91008
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 2047868
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 91009
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 834350
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 91010
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 1801299
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0