CMS Formulary

Displaying 115121-115130 of 1611142 results.
ID: 115121
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 349592
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 115122
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 349593
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 115123
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1011736
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 115124
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1011739
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 115125
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 388311
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 115126
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 200133
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 115127
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 200131
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 115128
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 861237
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 115129
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 861221
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 115130
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 861223
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30