CMS Formulary

Displaying 109291-109300 of 1611142 results.
ID: 109291
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 486148
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 109292
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 486152
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 109293
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 486146
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 109294
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 577057
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 10
Qty Limit Days: 30
ID: 109295
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 886634
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 5
Qty Limit Days: 28
ID: 109296
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1437702
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 540
Qty Limit Days: 30
ID: 109297
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 211343
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 109298
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 857002
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 109299
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 857005
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 109300
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 856999
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30