CMS Formulary

Displaying 113511-113520 of 1611142 results.
ID: 113511
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 861004
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 75
Qty Limit Days: 30
ID: 113512
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 861731
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 113513
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 562524
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 113514
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1652673
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 113515
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1649429
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 113516
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1650142
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 113517
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1650444
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 113518
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 406524
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 113519
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 434018
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 113520
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 799048
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0