CMS Formulary

Displaying 114621-114630 of 1611142 results.
ID: 114621
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 308739
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 25
ID: 114622
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1111343
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 114623
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 284008
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 25
ID: 114624
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 313919
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 3
Qty Limit Days: 28
ID: 114625
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1797865
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 34
Qty Limit Days: 28
ID: 114626
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1797867
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 25
ID: 114627
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 860107
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 10
Qty Limit Days: 25
ID: 114628
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 904481
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 114629
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 617312
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 114630
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 617310
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0