CMS Formulary

Displaying 115301-115310 of 1611142 results.
ID: 115301
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 312831
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 115302
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 312832
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 115303
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 314211
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 115304
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 199890
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 115305
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 845488
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 115306
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 861736
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 115307
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 861740
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 115308
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 312817
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 115309
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 577315
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 115310
Formulary ID: 00021043
Formulary Version: 14
Contract Year: 2021
RXCUI: 577317
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0