CMS Formulary

Displaying 104261-104270 of 1611142 results.
ID: 104261
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 896184
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 104262
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 896209
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 104263
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 896228
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 104264
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 861237
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 104265
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 861221
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 104266
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 861223
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 104267
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 861225
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 104268
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 861227
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 104269
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 861232
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 104270
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1367436
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28