CMS Formulary

Displaying 111901-111910 of 1611142 results.
ID: 111901
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1944376
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 111902
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1921081
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 30
ID: 111903
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1866047
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 111904
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1099026
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 111905
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1099269
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 111906
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1006065
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 111907
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1020155
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 91
Qty Limit Days: 84
ID: 111908
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1720616
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 111909
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1369737
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 111910
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1722676
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0