CMS Formulary

Displaying 96301-96310 of 1611142 results.
ID: 96301
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 205330
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 96302
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 205331
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 96303
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 999967
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 96304
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 999996
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 96305
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 999986
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 96306
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1000001
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 96307
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 999991
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 96308
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 984082
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 96309
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1551923
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 96310
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1601373
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30