CMS Formulary

Displaying 96671-96680 of 1611142 results.
ID: 96671
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 313407
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 96672
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 313408
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 96673
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1536490
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 96674
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 310878
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 96675
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1049696
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 96676
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 311982
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 96677
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 104884
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 96678
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 861430
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 96679
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 197939
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 96680
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 197940
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0