CMS Formulary

Displaying 114041-114050 of 1611142 results.
ID: 114041
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 993755
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 4500
Qty Limit Days: 30
ID: 114042
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 197448
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 114043
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1923432
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 114044
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 578018
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 114045
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 477391
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 114046
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 197877
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 114047
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1010739
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 114048
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 391937
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 114049
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 197305
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 114050
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 313786
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0