CMS Formulary

Displaying 114741-114750 of 1611142 results.
ID: 114741
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 854868
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 114742
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 2001564
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 114743
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1738803
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 114744
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1738805
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 114745
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1738807
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 114746
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 897584
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 114747
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 897590
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 114748
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 897596
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 114749
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 317769
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 114750
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 314208
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0