CMS Formulary

Displaying 94001-94010 of 1611142 results.
ID: 94001
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 861821
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 94002
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 861771
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 94003
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1729311
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 6
Qty Limit Days: 28
ID: 94004
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 2055766
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 94005
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1734642
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 94006
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1988671
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 28
Qty Limit Days: 28
ID: 94007
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1988675
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 28
Qty Limit Days: 28
ID: 94008
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1924315
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 94009
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1486841
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 94010
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 798300
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0