CMS Formulary

Displaying 102761-102770 of 1611142 results.
ID: 102761
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 200096
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 102762
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 197311
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 102763
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 197313
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 102764
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 313566
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 102765
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 485434
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 102766
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 485436
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 102767
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 859424
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 102768
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 859747
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 102769
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 859751
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 102770
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 859419
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30