CMS Formulary

Displaying 104911-104920 of 1611142 results.
ID: 104911
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 2268227
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 16
Qty Limit Days: 30
ID: 104912
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 402092
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 104913
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 861637
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104914
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 861206
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104915
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 904170
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104916
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 854859
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 104917
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 1859000
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 104918
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 1604544
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 13
Qty Limit Days: 28
ID: 104919
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 2002420
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 18
Qty Limit Days: 28
ID: 104920
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 1923338
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0