CMS Formulary

Displaying 104021-104030 of 1611142 results.
ID: 104021
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 2101459
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104022
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 2101465
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104023
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1926823
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 104024
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1926827
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 20
Qty Limit Days: 30
ID: 104025
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1809513
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104026
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1876671
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104027
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1876673
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104028
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1876674
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104029
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1812434
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104030
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 866111
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0