CMS Formulary

Displaying 113411-113420 of 1611142 results.
ID: 113411
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 615882
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 113412
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 284496
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 113413
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 197848
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 113414
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 855926
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 113415
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 855906
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 113416
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 855664
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 150
Qty Limit Days: 30
ID: 113417
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 995281
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 113418
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1095227
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 113419
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1304988
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 113420
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1661092
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 91
Qty Limit Days: 84