CMS Formulary

Displaying 115671-115680 of 1611142 results.
ID: 115671
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 582971
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 115672
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 582976
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 115673
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 1435117
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 115674
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 351859
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 40
Qty Limit Days: 28
ID: 115675
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 1731317
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 24
Qty Limit Days: 28
ID: 115676
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 643177
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 115677
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 643173
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 115678
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 643175
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 115679
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 799830
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 115680
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 1045408
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30