CMS Formulary

Displaying 104811-104820 of 1611142 results.
ID: 104811
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 207834
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104812
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 1718936
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 104813
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 1745114
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104814
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 729234
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104815
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 582971
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104816
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 582976
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104817
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 1435117
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 104818
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 351859
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 40
Qty Limit Days: 28
ID: 104819
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 1731317
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 24
Qty Limit Days: 28
ID: 104820
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 643177
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30