CMS Formulary

Displaying 109011-109020 of 1611142 results.
ID: 109011
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 2398842
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 3
Qty Limit Days: 28
ID: 109012
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1991311
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 3
Qty Limit Days: 28
ID: 109013
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1991317
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 3
Qty Limit Days: 28
ID: 109014
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 2200654
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 109015
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 2200658
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 109016
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 2200650
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 109017
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1653204
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 28
ID: 109018
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 351926
NDC:
Tier Level: 6
Qty Limit?: 0
Qty Limit Amt: 40
Qty Limit Days: 28
ID: 109019
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 849851
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 109020
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 847247
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0