CMS Formulary

Displaying 109001-109010 of 1611142 results.
ID: 109001
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 2206092
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 28
ID: 109002
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 2206099
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 28
ID: 109003
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 2049380
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 28
ID: 109004
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1986354
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 40
Qty Limit Days: 28
ID: 109005
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1986356
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 28
ID: 109006
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 2205454
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 28
ID: 109007
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1653198
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 28
ID: 109008
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 977842
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 40
Qty Limit Days: 28
ID: 109009
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 977840
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 28
ID: 109010
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 897126
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 9
Qty Limit Days: 30