CMS Formulary

Displaying 95121-95130 of 1611142 results.
ID: 95121
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 562251
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 95122
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 617995
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 95123
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 198316
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 95124
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 359296
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 95125
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 308212
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 95126
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 403810
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 95127
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 403811
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 95128
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1806195
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 95129
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1806179
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 95130
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1806183
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30