CMS Formulary

Displaying 104641-104650 of 1611142 results.
ID: 104641
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 2049133
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 104642
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 2049121
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 104643
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1855072
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 104644
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1986331
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 104645
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1918230
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 104646
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 2054269
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104647
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 2362178
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 104648
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 2362182
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 104649
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 432400
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 104650
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1940654
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30