CMS Formulary

Displaying 97171-97180 of 1611142 results.
ID: 97171
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 141850
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 97172
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 197573
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 97173
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 2123072
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 17
Qty Limit Days: 30
ID: 97174
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 314076
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 97175
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 314077
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 97176
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 205326
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 97177
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 646456
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 97178
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1487251
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 97179
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 848768
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 30
ID: 97180
Formulary ID: 00021037
Formulary Version: 14
Contract Year: 2021
RXCUI: 1738511
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0