CMS Formulary

Displaying 97021-97030 of 1611142 results.
ID: 97021
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 349592
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 97022
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 349593
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 97023
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1011736
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 97024
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1011739
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 97025
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 388311
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 97026
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 200133
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 97027
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 200131
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 97028
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 861237
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 97029
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 861221
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 97030
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 861223
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30