CMS Formulary

Displaying 93051-93060 of 1611142 results.
ID: 93051
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 403854
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 93052
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 403855
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 93053
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 859981
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 93054
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 859975
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 93055
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 283316
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 93056
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 283317
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 93057
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 477130
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 93058
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 849389
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 93059
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 313407
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 93060
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 313408
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0