CMS Formulary

Displaying 108411-108420 of 1611142 results.
ID: 108411
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 105590
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 108412
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 1364498
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 45
Qty Limit Days: 30
ID: 108413
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 1364490
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 108414
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 1364494
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 108415
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 1648772
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 108416
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 884077
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 108417
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 2046597
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 228
Qty Limit Days: 14
ID: 108418
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 1989117
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 30
ID: 108419
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 2178792
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 30
ID: 108420
Formulary ID: 00021040
Formulary Version: 14
Contract Year: 2021
RXCUI: 644304
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0