CMS Formulary

Displaying 109151-109160 of 1611142 results.
ID: 109151
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1593833
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 109152
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1593835
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 109153
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1593775
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 109154
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 861045
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 10
Qty Limit Days: 28
ID: 109155
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 861043
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 10
Qty Limit Days: 28
ID: 109156
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 206347
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 109157
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 801357
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 109158
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 801112
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 109159
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 801136
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 109160
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1799706
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0