CMS Formulary

Displaying 103961-103970 of 1611142 results.
ID: 103961
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 212118
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 103962
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 542370
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 103963
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1988768
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 103964
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1921228
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 103965
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1988772
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 103966
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1988786
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 103967
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1723763
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 3
Qty Limit Days: 28
ID: 103968
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1723767
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 3
Qty Limit Days: 28
ID: 103969
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1723772
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 3
Qty Limit Days: 28
ID: 103970
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1726639
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30