CMS Formulary

Displaying 115241-115250 of 1611142 results.
ID: 115241
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 312122
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 42
Qty Limit Days: 180
ID: 115242
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 200346
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 115243
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 308135
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 115244
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 309054
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 115245
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 848140
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 115246
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 848131
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 115247
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 848145
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 115248
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 848151
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 115249
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 848135
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 115250
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 854894
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30