CMS Formulary

Displaying 92671-92680 of 1611142 results.
ID: 92671
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 310353
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 92672
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 200257
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 92673
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 200256
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 92674
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 200258
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 92675
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 313582
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 92676
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 313584
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 92677
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 314277
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 92678
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 313586
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 92679
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 311759
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 92680
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 866511
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0