CMS Formulary

Displaying 113721-113730 of 1611142 results.
ID: 113721
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 2468316
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 150
Qty Limit Days: 30
ID: 113722
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 2381144
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 113723
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 465355
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 113724
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 979099
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 113725
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 967023
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 113726
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 967012
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 113727
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 198332
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 113728
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 856987
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 113729
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 856992
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 113730
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 197702
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0