CMS Formulary

Displaying 108651-108660 of 1611142 results.
ID: 108651
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 2058922
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 108652
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 2103175
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 108653
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 2103179
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 108654
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 810075
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 108655
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 810079
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 108656
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 2284108
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 21
Qty Limit Days: 28
ID: 108657
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 2057205
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 108658
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 2057216
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 108659
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 2057212
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 108660
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 2057219
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0