CMS Formulary

Displaying 91191-91200 of 1611142 results.
ID: 91191
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 486148
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 91192
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 486152
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 91193
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 486146
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 91194
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 577057
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 10
Qty Limit Days: 30
ID: 91195
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 886634
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 5
Qty Limit Days: 28
ID: 91196
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 1437702
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 540
Qty Limit Days: 30
ID: 91197
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 211343
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 91198
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 857002
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 91199
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 857005
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 91200
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 856999
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30