CMS Formulary

Displaying 108801-108810 of 1611142 results.
ID: 108801
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 857461
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 108802
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 978006
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 108803
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 834022
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 20
Qty Limit Days: 30
ID: 108804
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 833217
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 108805
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 831103
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 108806
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 831102
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 108807
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 831054
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 108808
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 197724
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 108809
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 197381
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 108810
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 197379
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0