CMS Formulary

Displaying 104451-104460 of 1611142 results.
ID: 104451
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 905158
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104452
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 199376
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104453
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 199381
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104454
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 898490
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104455
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 686429
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104456
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 284201
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 6
Qty Limit Days: 30
ID: 104457
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 351134
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 6
Qty Limit Days: 30
ID: 104458
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 314142
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 104459
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 311919
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 104460
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1988308
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0