CMS Formulary

Displaying 113811-113820 of 1611142 results.
ID: 113811
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 863538
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 113812
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1665507
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 113813
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1191299
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 113814
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 240209
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 113815
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1797883
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 25
ID: 113816
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 318202
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 113817
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 238600
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 113818
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 141859
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 5
Qty Limit Days: 4
ID: 113819
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 310465
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 113820
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1085640
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0