CMS Formulary

Displaying 96911-96920 of 1611142 results.
ID: 96911
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 313160
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 9
Qty Limit Days: 30
ID: 96912
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 854873
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 96913
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 310796
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 96914
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 310797
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 96915
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 310809
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 96916
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 198052
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 96917
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 312086
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 96918
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 310384
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 96919
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 310385
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 96920
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 313989
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0