CMS Formulary

Displaying 108601-108610 of 1611142 results.
ID: 108601
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1049604
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 1300
Qty Limit Days: 30
ID: 108602
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1874559
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 108603
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1874553
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 108604
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 900575
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 108605
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 977427
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 108606
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 977434
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 108607
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 977438
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 108608
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 892625
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 108609
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 311355
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 108610
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 197893
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0