CMS Formulary

Displaying 104251-104260 of 1611142 results.
ID: 104251
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 861654
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 104252
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 2123076
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 36
Qty Limit Days: 30
ID: 104253
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 349591
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 104254
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 349592
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 104255
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 349593
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 104256
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1011736
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104257
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1011739
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104258
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 388311
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104259
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 200133
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104260
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 200131
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0