CMS Formulary

Displaying 103461-103470 of 1611142 results.
ID: 103461
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1657151
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 103462
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 994008
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 103463
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 900156
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 103464
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 848582
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 103465
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 824959
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 103466
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 749206
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 103467
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1659592
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 103468
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1659598
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 103469
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 240984
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 103470
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1659131
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0