CMS Formulary

Displaying 91911-91920 of 1611142 results.
ID: 91911
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 309313
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 600
Qty Limit Days: 30
ID: 91912
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 351285
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 91913
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 2123194
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 91914
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 313565
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 91915
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 313564
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 91916
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 199885
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 91917
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 242438
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 91918
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 200094
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 91919
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 200095
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 91920
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 200096
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0