CMS Formulary

Displaying 114401-114410 of 1611142 results.
ID: 114401
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 205330
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 114402
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 205331
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 114403
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 999967
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 114404
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 999996
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 114405
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 999986
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 114406
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1000001
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 114407
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 999991
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 114408
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 984082
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 114409
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1551923
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 114410
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1601373
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30