CMS Formulary

Displaying 105121-105130 of 1611142 results.
ID: 105121
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 1425110
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 105122
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 1425118
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 105123
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 867506
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 105124
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 1425230
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 105125
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 1425228
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 105126
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 1245003
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 105127
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 825425
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 105128
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 825429
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 105129
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 884619
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 105130
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 2121061
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 84
Qty Limit Days: 28