CMS Formulary

Displaying 108961-108970 of 1611142 results.
ID: 108961
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 856940
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 2700
Qty Limit Days: 30
ID: 108962
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 834137
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 108963
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 810002
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 108964
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 809990
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 108965
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 809994
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 108966
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 809998
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 108967
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 995156
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1200
Qty Limit Days: 30
ID: 108968
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 308963
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 108969
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 317173
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 108970
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 308964
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0