CMS Formulary

Displaying 91441-91450 of 1611142 results.
ID: 91441
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 805515
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 91442
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 603378
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 91443
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 1190225
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 8
Qty Limit Days: 30
ID: 91444
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 580261
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 91445
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 836368
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 25
Qty Limit Days: 28
ID: 91446
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 1552004
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 30
ID: 91447
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 1723478
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 91448
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 1430453
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 91449
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 1430457
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 91450
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 1100706
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30