CMS Formulary

Displaying 103101-103110 of 1611142 results.
ID: 103101
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 351276
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 103102
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 728207
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 103103
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 349194
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 103104
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 349195
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 103105
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 349198
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 103106
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 403825
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 103107
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 312439
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 103108
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 198103
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 103109
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 250820
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 103110
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 858751
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0