CMS Formulary

Displaying 108871-108880 of 1611142 results.
ID: 108871
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 904876
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 108872
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1314763
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 108873
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 309047
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 108874
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 312594
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 108875
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 198141
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 108876
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 834046
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 108877
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 834040
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 108878
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 197536
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 108879
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 429212
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 108880
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 309374
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 135
Qty Limit Days: 30