CMS Formulary

Displaying 104181-104190 of 1611142 results.
ID: 104181
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 311296
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104182
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 200285
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104183
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 349353
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104184
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 636042
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104185
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 636045
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104186
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 251872
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 104187
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 314200
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 104188
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 349483
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104189
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 349199
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104190
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 349200
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0