CMS Formulary

Displaying 95411-95420 of 1611142 results.
ID: 95411
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 861004
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 75
Qty Limit Days: 30
ID: 95412
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 861731
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 95413
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 562524
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 95414
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1652673
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 95415
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1649429
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 95416
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1650142
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 95417
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1650444
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 95418
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 406524
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 95419
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 434018
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 95420
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 799048
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0