CMS Formulary

Displaying 104351-104360 of 1611142 results.
ID: 104351
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 309110
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104352
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 309113
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104353
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 200345
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 104354
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 197903
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104355
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 197904
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104356
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 197905
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104357
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 311353
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104358
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 311354
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104359
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 197884
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104360
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 197885
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0