CMS Formulary

Displaying 104041-104050 of 1611142 results.
ID: 104041
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1790892
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 104042
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1790886
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 104043
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1790890
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 104044
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 2384465
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 5
Qty Limit Days: 28
ID: 104045
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1670324
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 80
Qty Limit Days: 28
ID: 104046
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1670322
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 100
Qty Limit Days: 28
ID: 104047
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 977923
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 104048
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 977929
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 104049
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 977874
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 104050
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 977894
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30