CMS Formulary

Displaying 105491-105500 of 1611142 results.
ID: 105491
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 351175
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 105492
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 794639
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 105493
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 616578
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 105494
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 801417
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 105495
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 204520
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 105496
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 1799890
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 105497
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 800928
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 105498
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 800812
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 105499
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 1189640
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 105500
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 800933
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0