CMS Formulary

Displaying 12111-12120 of 1611142 results.
ID: 12111
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 731571
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 12112
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 1049223
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 30
ID: 12113
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 1049227
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 12114
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 1049216
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 12115
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 854801
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 12116
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 313477
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 12117
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 861200
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 12118
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 1000647
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 12119
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 1000862
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 12120
Formulary ID: 00021003
Formulary Version: 14
Contract Year: 2021
RXCUI: 1000897
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0