CMS Formulary

Displaying 107801-107810 of 1611142 results.
ID: 107801
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 433798
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 107802
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 433800
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 107803
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 433799
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 107804
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 433801
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 107805
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 979468
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 107806
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 979464
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 107807
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 979471
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 107808
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 198188
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 107809
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 313134
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 107810
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 562508
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0