CMS Formulary

Displaying 91111-91120 of 1611142 results.
ID: 91111
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 198285
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 91112
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 856422
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 91113
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 199903
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 91114
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 998671
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 91115
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 998675
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 91116
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 998679
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 8
Qty Limit Days: 28
ID: 91117
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 1000048
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 91118
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 876524
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 91119
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 876514
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 91120
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 876529
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0