CMS Formulary

Displaying 103161-103170 of 1611142 results.
ID: 103161
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1727485
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 103162
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1441530
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 103163
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1242998
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 103164
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 2106075
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 103165
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 2390946
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 103166
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 2058950
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 103167
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 2058946
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 103168
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1722376
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 63
Qty Limit Days: 28
ID: 103169
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 2100099
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 180
ID: 103170
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 2100100
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 180