CMS Formulary

Displaying 112461-112470 of 1611142 results.
ID: 112461
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 197454
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 112462
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 308177
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 112463
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 598025
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 112464
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 617309
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 112465
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 617316
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 112466
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 617296
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 112467
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 757707
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 112468
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 403957
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 112469
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 636664
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 112470
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 608328
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0