CMS Formulary

Displaying 104551-104560 of 1611142 results.
ID: 104551
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 352257
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 540
Qty Limit Days: 30
ID: 104552
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 2393794
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 540
Qty Limit Days: 30
ID: 104553
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 2121764
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 104554
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 2173841
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 104555
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1364477
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104556
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1602028
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 104557
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1602034
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 104558
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1602040
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 104559
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1602046
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 104560
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 2265729
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30