CMS Formulary

Displaying 96881-96890 of 1611142 results.
ID: 96881
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 979115
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 16
Qty Limit Days: 28
ID: 96882
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1244062
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 16
Qty Limit Days: 28
ID: 96883
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1244064
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 11
Qty Limit Days: 28
ID: 96884
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1596778
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 96885
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1673274
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28
ID: 96886
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1673278
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 96887
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1673280
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 3
Qty Limit Days: 28
ID: 96888
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1925264
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 3
Qty Limit Days: 56
ID: 96889
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 2049343
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 365
ID: 96890
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 312941
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0