CMS Formulary

Displaying 105381-105390 of 1611142 results.
ID: 105381
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 1991311
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 3
Qty Limit Days: 28
ID: 105382
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 1991317
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 3
Qty Limit Days: 28
ID: 105383
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 2200654
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 105384
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 2200658
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 105385
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 2200650
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 105386
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 1653204
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 28
ID: 105387
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 351926
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 40
Qty Limit Days: 28
ID: 105388
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 849851
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 105389
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 847247
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 105390
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 847348
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0