CMS Formulary

Displaying 113111-113120 of 1611142 results.
ID: 113111
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 315107
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 113112
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 310489
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 113113
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 250344
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 113114
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 722122
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 113115
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 722116
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 113116
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 198250
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 113117
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 197502
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 113118
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 863559
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 113119
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1431286
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 113120
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 897612
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0