CMS Formulary

Displaying 115081-115090 of 1611142 results.
ID: 115081
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1800499
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 115082
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1800500
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 115083
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 992150
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 115084
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 724863
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 115085
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 724859
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 115086
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 724861
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 115087
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 403818
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 115088
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 730869
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 115089
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 897021
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 115090
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 2049264
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 91
Qty Limit Days: 84