CMS Formulary

Displaying 96691-96700 of 1611142 results.
ID: 96691
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 835829
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 96692
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 860975
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 96693
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 860981
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 96694
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 312136
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 96695
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 312137
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 96696
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1299911
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 96697
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 855861
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 96698
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 197890
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 96699
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 855873
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 96700
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 2360548
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0