CMS Formulary

Displaying 113541-113550 of 1611142 results.
ID: 113541
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 850309
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 113542
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 310015
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 113543
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1988399
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 5
Qty Limit Days: 30
ID: 113544
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1150836
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 113545
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 2118539
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 113546
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 864650
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 113547
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 308511
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 113548
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1375922
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 113549
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 863042
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 113550
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 204423
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0