CMS Formulary

Displaying 103021-103030 of 1611142 results.
ID: 103021
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 2167567
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 103022
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 2167571
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 103023
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1648755
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 103024
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 725021
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 103025
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 725023
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 103026
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 311994
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 103027
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 311995
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 103028
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1648759
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 103029
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 903847
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 103030
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1307061
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30