CMS Formulary

Displaying 104411-104420 of 1611142 results.
ID: 104411
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 314077
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104412
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 205326
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104413
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 646456
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 104414
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1487251
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 104415
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 848768
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 30
ID: 104416
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1738511
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104417
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 205316
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104418
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 205315
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104419
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 313583
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 104420
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 313585
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30