CMS Formulary

Displaying 95391-95400 of 1611142 results.
ID: 95391
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 312641
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 95392
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1312625
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 95393
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1365660
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 95394
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1365847
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 95395
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1365850
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 95396
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1928954
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 95397
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1090641
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 95398
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 905222
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 95399
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 197855
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 95400
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 197856
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0