CMS Formulary

Displaying 101351-101360 of 1611142 results.
ID: 101351
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 197730
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 101352
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 197731
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 101353
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 311376
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 150
Qty Limit Days: 30
ID: 101354
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 864761
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 1200
Qty Limit Days: 30
ID: 101355
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 864769
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 600
Qty Limit Days: 30
ID: 101356
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 315187
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 101357
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 856724
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 101358
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 856733
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 101359
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 309371
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 101360
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 197577
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0