CMS Formulary

Displaying 104361-104370 of 1611142 results.
ID: 104361
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 197886
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104362
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 197887
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104363
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 314203
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104364
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 312749
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104365
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 199353
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104366
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 199351
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104367
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 199352
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104368
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 198189
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104369
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 261962
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104370
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 199147
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0