CMS Formulary

Displaying 91701-91710 of 1611142 results.
ID: 91701
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 197848
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 91702
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 855926
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 91703
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 855906
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 91704
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 855664
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 150
Qty Limit Days: 30
ID: 91705
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 995281
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 91706
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 1095227
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 91707
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 1304988
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 91708
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 1661092
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 91
Qty Limit Days: 84
ID: 91709
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 309079
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 91710
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 1438778
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0