CMS Formulary

Displaying 93371-93380 of 1611142 results.
ID: 93371
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 992150
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 93372
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 724863
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 93373
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 724859
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 93374
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 724861
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 93375
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 403818
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 93376
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 730869
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 93377
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 897021
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 93378
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 2049264
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 91
Qty Limit Days: 84
ID: 93379
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 1856424
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 93380
Formulary ID: 00021036
Formulary Version: 14
Contract Year: 2021
RXCUI: 2052064
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0