CMS Formulary

Displaying 109211-109220 of 1611142 results.
ID: 109211
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 198285
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 109212
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 856422
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 109213
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 199903
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 109214
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 998671
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 109215
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 998675
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 109216
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 998679
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 8
Qty Limit Days: 28
ID: 109217
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1000048
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 109218
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 876524
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 109219
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 876514
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 109220
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 876529
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0