CMS Formulary

Displaying 93001-93010 of 1611142 results.
ID: 93001
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 1544475
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 93002
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 1591949
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 28
Qty Limit Days: 28
ID: 93003
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 2204104
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 56
Qty Limit Days: 28
ID: 93004
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 2204102
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 28
Qty Limit Days: 28
ID: 93005
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 1721619
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 93006
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 1747697
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 93007
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 1741739
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 93008
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 1799218
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 28
Qty Limit Days: 28
ID: 93009
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 2288816
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 28
Qty Limit Days: 28
ID: 93010
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 1858267
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30