CMS Formulary

Displaying 96801-96810 of 1611142 results.
ID: 96801
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 2261794
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 96802
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1040058
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 96803
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 858804
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 96804
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 794641
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 96805
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 902624
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 96806
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 902626
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 96807
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 617768
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 96808
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1790892
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 96809
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1790886
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 96810
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1790890
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30