CMS Formulary

Displaying 99021-99030 of 1611142 results.
ID: 99021
Formulary ID: 00021038
Formulary Version: 14
Contract Year: 2021
RXCUI: 861007
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 150
Qty Limit Days: 30
ID: 99022
Formulary ID: 00021038
Formulary Version: 14
Contract Year: 2021
RXCUI: 861010
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 99023
Formulary ID: 00021038
Formulary Version: 14
Contract Year: 2021
RXCUI: 861004
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 75
Qty Limit Days: 30
ID: 99024
Formulary ID: 00021038
Formulary Version: 14
Contract Year: 2021
RXCUI: 861731
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 99025
Formulary ID: 00021038
Formulary Version: 14
Contract Year: 2021
RXCUI: 562524
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 99026
Formulary ID: 00021038
Formulary Version: 14
Contract Year: 2021
RXCUI: 1652673
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 99027
Formulary ID: 00021038
Formulary Version: 14
Contract Year: 2021
RXCUI: 1649429
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 99028
Formulary ID: 00021038
Formulary Version: 14
Contract Year: 2021
RXCUI: 1650142
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 99029
Formulary ID: 00021038
Formulary Version: 14
Contract Year: 2021
RXCUI: 1650444
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 99030
Formulary ID: 00021038
Formulary Version: 14
Contract Year: 2021
RXCUI: 406524
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0