CMS Formulary

Displaying 109651-109660 of 1611142 results.
ID: 109651
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 617423
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 109652
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 617993
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 109653
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 314227
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 12
Qty Limit Days: 30
ID: 109654
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 142046
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 109655
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 244374
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 109656
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 238004
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 109657
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 313921
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 109658
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 238003
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 109659
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 403923
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 109660
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 241946
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 8
Qty Limit Days: 28