CMS Formulary

Displaying 117761-117770 of 1611142 results.
ID: 117761
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 308715
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 117762
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 848208
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 117763
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 848176
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 117764
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 848178
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 117765
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 861505
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 117766
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 313200
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 117767
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 103456
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 117768
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 310891
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 117769
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 308979
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 117770
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 197686
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0