CMS Formulary

Displaying 109791-109800 of 1611142 results.
ID: 109791
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1091170
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 109792
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1091185
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 109793
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 1091210
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 109794
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 808751
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 109795
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 808753
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 109796
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 808744
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 109797
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 861601
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 109798
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 861597
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 109799
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 615882
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 109800
Formulary ID: 00021042
Formulary Version: 14
Contract Year: 2021
RXCUI: 284496
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0