CMS Formulary

Displaying 114221-114230 of 1611142 results.
ID: 114221
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1012904
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 114222
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1010696
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 114223
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 312839
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 12
Qty Limit Days: 30
ID: 114224
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 312837
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 12
Qty Limit Days: 30
ID: 114225
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1091341
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 900
Qty Limit Days: 30
ID: 114226
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1359124
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 114227
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 403884
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 114228
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 310599
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 114229
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 856535
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 114230
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 856569
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0