CMS Formulary

Displaying 117121-117130 of 1611142 results.
ID: 117121
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 861007
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 150
Qty Limit Days: 30
ID: 117122
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 861010
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 117123
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 861004
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 75
Qty Limit Days: 30
ID: 117124
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 861731
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 117125
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 562524
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 117126
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 1652673
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 117127
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 1649429
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 117128
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 1650142
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 117129
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 1650444
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 117130
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 406524
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0