CMS Formulary

Displaying 97131-97140 of 1611142 results.
ID: 97131
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 199352
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 97132
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 198189
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 97133
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 261962
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 97134
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 199147
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 97135
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 349491
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 97136
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 853201
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 97137
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1649990
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 97138
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1650030
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 97139
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 198201
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 97140
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 728109
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 84
Qty Limit Days: 180