CMS Formulary

Displaying 109691-109700 of 1611142 results.
ID: 109691
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 854245
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 48
Qty Limit Days: 30
ID: 109692
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 854252
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 109693
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 406503
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 109694
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 858262
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 109695
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 310023
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 109696
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 403890
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 109697
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 197549
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 109698
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 197550
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 109699
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 2102717
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 109700
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 2102713
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30