CMS Formulary

Displaying 104801-104810 of 1611142 results.
ID: 104801
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 2395785
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 104802
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 2370170
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 104803
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 2047247
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104804
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 2256947
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 8
Qty Limit Days: 30
ID: 104805
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 1946836
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 56
Qty Limit Days: 28
ID: 104806
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 2256943
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 8
Qty Limit Days: 30
ID: 104807
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 2205474
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104808
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 1946840
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 56
Qty Limit Days: 28
ID: 104809
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 1946844
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 56
Qty Limit Days: 28
ID: 104810
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 1946848
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 56
Qty Limit Days: 28