CMS Formulary

Displaying 112821-112830 of 1611142 results.
ID: 112821
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 198270
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 112822
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 197960
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 112823
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 198285
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 112824
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 856422
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 112825
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 199903
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 112826
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 998671
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 112827
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 998675
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 112828
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 998679
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 8
Qty Limit Days: 28
ID: 112829
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1000048
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 112830
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 876524
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0