CMS Formulary

Displaying 108381-108390 of 1611142 results.
ID: 108381
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 2467571
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 108382
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 2467575
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 108383
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 2286261
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 108384
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 2472789
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 108385
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 311040
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 40
Qty Limit Days: 28
ID: 108386
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 1653196
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 28
ID: 108387
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 1653202
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 28
ID: 108388
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 351297
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 40
Qty Limit Days: 28
ID: 108389
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 847191
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 28
ID: 108390
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 2478450
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30