CMS Formulary

Displaying 104691-104700 of 1611142 results.
ID: 104691
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 2283505
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 104692
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 2283515
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 56
Qty Limit Days: 28
ID: 104693
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 2283518
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 56
Qty Limit Days: 28
ID: 104694
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 2283509
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 104695
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 2283513
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 104696
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 2283538
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104697
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 2283536
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104698
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 2283540
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104699
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 311944
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104700
Formulary ID: 00021039
Formulary Version: 14
Contract Year: 2021
RXCUI: 1999314
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0