CMS Formulary

Displaying 104011-104020 of 1611142 results.
ID: 104011
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1482523
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 104012
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1482527
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 104013
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1235249
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 104014
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1040036
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 104015
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1431237
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 104016
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1040043
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 104017
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1297357
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 104018
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1356693
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104019
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1442681
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104020
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1442683
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0