CMS Formulary

Displaying 109611-109620 of 1611142 results.
ID: 109611
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 198316
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 109612
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 359296
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 109613
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 308212
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 109614
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 403810
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 109615
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 403811
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 109616
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1806195
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 109617
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1806179
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 109618
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1806183
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 109619
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 308191
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 109620
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 199119
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0