CMS Formulary

Displaying 109431-109440 of 1611142 results.
ID: 109431
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 197554
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 109432
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 197555
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 109433
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 856369
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 109434
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1009145
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 109435
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 687043
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 109436
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 577957
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 109437
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1000114
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 109438
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 199159
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 109439
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1000135
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 109440
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1000141
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0