CMS Formulary

Displaying 93241-93250 of 1611142 results.
ID: 93241
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 857340
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 93242
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 259081
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 93243
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 835603
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 93244
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 283536
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 93245
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 199387
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 480
Qty Limit Days: 30
ID: 93246
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 312085
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 93247
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 308429
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 93248
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 283523
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 2160
Qty Limit Days: 30
ID: 93249
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 197745
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 93250
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 197746
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0