CMS Formulary

Displaying 108501-108510 of 1611142 results.
ID: 108501
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 836636
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 108502
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 836634
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 108503
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1597099
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 365
ID: 108504
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1597103
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 365
ID: 108505
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1292443
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 108506
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 804186
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 108507
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1292459
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 365
ID: 108508
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1658106
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 108509
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1658102
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 108510
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 798451
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0