CMS Formulary

Displaying 95021-95030 of 1611142 results.
ID: 95021
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 897618
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 95022
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 897624
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 95023
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 897630
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 95024
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 312025
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 95025
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 198041
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 95026
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 582926
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 95027
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1597123
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 300
Qty Limit Days: 30
ID: 95028
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1597129
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 300
Qty Limit Days: 30
ID: 95029
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 238134
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 95030
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1745091
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30