CMS Formulary

Displaying 105371-105380 of 1611142 results.
ID: 105371
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 2206099
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 28
ID: 105372
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 2049380
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 28
ID: 105373
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 1986354
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 40
Qty Limit Days: 28
ID: 105374
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 1986356
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 28
ID: 105375
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 2205454
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 28
ID: 105376
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 1653198
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 28
ID: 105377
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 977842
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 40
Qty Limit Days: 28
ID: 105378
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 977840
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 28
ID: 105379
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 897126
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 9
Qty Limit Days: 30
ID: 105380
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 2398842
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 3
Qty Limit Days: 28