CMS Formulary

Displaying 119061-119070 of 1611142 results.
ID: 119061
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 310431
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 30
ID: 119062
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 728113
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 48
Qty Limit Days: 180
ID: 119063
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 483442
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 119064
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 483448
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 119065
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 483446
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 119066
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 312515
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 119067
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 1795598
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 119068
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 1366192
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 480
Qty Limit Days: 30
ID: 119069
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 1796922
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 119070
Formulary ID: 00021045
Formulary Version: 14
Contract Year: 2021
RXCUI: 1744001
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0