CMS Formulary

Displaying 104061-104070 of 1611142 results.
ID: 104061
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 309077
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104062
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 313428
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104063
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 242680
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104064
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 205292
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104065
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 205290
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104066
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 315134
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104067
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 866021
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104068
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1992303
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104069
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 427163
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104070
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 2399892
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 8
Qty Limit Days: 28