CMS Formulary

Displaying 103921-103930 of 1611142 results.
ID: 103921
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 476349
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 103922
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 476350
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 103923
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 476351
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 103924
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 835829
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 103925
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 860975
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 103926
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 860981
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 103927
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 312136
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 103928
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 312137
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 103929
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1299911
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 103930
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 855861
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0