CMS Formulary

Displaying 103801-103810 of 1611142 results.
ID: 103801
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1000862
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 103802
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1000897
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 103803
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1923428
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 103804
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 831109
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 103805
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 978573
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 103806
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 308720
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 103807
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1605071
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 103808
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1605075
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 103809
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 314072
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 25
ID: 103810
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 244967
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0