CMS Formulary

Displaying 116701-116710 of 1611142 results.
ID: 116701
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 310191
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 116702
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 261178
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 116703
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 313941
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 300
Qty Limit Days: 30
ID: 116704
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 198300
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 116705
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 106303
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 116706
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 313450
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 116707
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 313451
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 116708
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 308508
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 116709
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 310149
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 3
Qty Limit Days: 4
ID: 116710
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 1000673
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0