CMS Formulary

Displaying 103791-103800 of 1611142 results.
ID: 103791
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 731571
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 103792
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 476872
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 103793
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1049223
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 30
ID: 103794
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1049227
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 103795
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1049216
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 103796
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 854801
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 103797
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 313477
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 103798
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 861200
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 103799
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 861208
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 103800
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1000647
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0