CMS Formulary

Displaying 114251-114260 of 1611142 results.
ID: 114251
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1091635
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 114252
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1091638
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 114253
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1091623
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 114254
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1543069
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 114255
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1010878
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 114256
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1085741
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 114257
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1191302
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 114258
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 310152
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 114259
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1370763
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 118
Qty Limit Days: 30
ID: 114260
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 2180999
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0