CMS Formulary

Displaying 117621-117630 of 1611142 results.
ID: 117621
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 204844
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 117622
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 198372
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 117623
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 198369
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 117624
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 198370
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 117625
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 1242819
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 3
Qty Limit Days: 56
ID: 117626
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 1242815
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 56
ID: 117627
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 616749
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 117628
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 728231
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 117629
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 2391560
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 117630
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 1657212
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0