CMS Formulary

Displaying 117001-117010 of 1611142 results.
ID: 117001
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 349547
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 117002
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 730866
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 117003
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 730861
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 117004
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 730872
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 117005
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 856373
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 117006
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 900164
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 117007
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 850091
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 117008
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 850087
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 117009
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 310288
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 117010
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 197985
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0