CMS Formulary

Displaying 95381-95390 of 1611142 results.
ID: 95381
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 863628
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 95382
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 314080
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 95383
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1190655
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 95384
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 545236
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 95385
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1724340
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 95386
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1244616
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 95387
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 312075
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 95388
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 308345
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 95389
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 197636
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 95390
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 260243
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0