CMS Formulary

Displaying 93041-93050 of 1611142 results.
ID: 93041
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 205285
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 93042
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 643019
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 93043
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 643022
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 93044
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 866482
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 93045
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 866479
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 93046
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 349401
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 93047
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 349405
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 93048
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 205322
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 93049
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 205323
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 93050
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 403853
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0