CMS Formulary

Displaying 115131-115140 of 1611142 results.
ID: 115131
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 861225
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 115132
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 861227
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 115133
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 861232
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 115134
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1367436
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28
ID: 115135
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 352210
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 115136
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 198175
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 115137
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1361615
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 115138
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 1361226
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 115139
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 861363
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 115140
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 861365
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0