CMS Formulary

Displaying 104531-104540 of 1611142 results.
ID: 104531
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 308725
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 420
Qty Limit Days: 30
ID: 104532
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 855657
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 104533
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1812011
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104534
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1812013
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104535
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 562806
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 100
Qty Limit Days: 30
ID: 104536
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 825130
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104537
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 260260
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104538
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1370758
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 104539
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 311382
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104540
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 861668
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 8
Qty Limit Days: 28