CMS Formulary

Displaying 112191-112200 of 1611142 results.
ID: 112191
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1797833
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 28
ID: 112192
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1797844
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 15
Qty Limit Days: 10
ID: 112193
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 885857
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 112194
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 860901
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 200
Qty Limit Days: 30
ID: 112195
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 351265
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 112196
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 351266
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 112197
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 351267
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 112198
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 905172
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 112199
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 905168
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 112200
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 892589
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 700
Qty Limit Days: 30