CMS Formulary

Displaying 114011-114020 of 1611142 results.
ID: 114011
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 198369
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 114012
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 198370
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 114013
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1242819
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 3
Qty Limit Days: 56
ID: 114014
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1242815
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 56
ID: 114015
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 616749
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 114016
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 728231
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 114017
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 2391560
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 114018
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1657212
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 114019
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1735537
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 114020
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 992403
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0