CMS Formulary

Displaying 100121-100130 of 1611142 results.
ID: 100121
Formulary ID: 00021038
Formulary Version: 14
Contract Year: 2021
RXCUI: 310490
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 100122
Formulary ID: 00021038
Formulary Version: 14
Contract Year: 2021
RXCUI: 310488
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 100123
Formulary ID: 00021038
Formulary Version: 14
Contract Year: 2021
RXCUI: 993687
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 100124
Formulary ID: 00021038
Formulary Version: 14
Contract Year: 2021
RXCUI: 993691
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 100125
Formulary ID: 00021038
Formulary Version: 14
Contract Year: 2021
RXCUI: 903887
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 100126
Formulary ID: 00021038
Formulary Version: 14
Contract Year: 2021
RXCUI: 903891
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 100127
Formulary ID: 00021038
Formulary Version: 14
Contract Year: 2021
RXCUI: 903884
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 100128
Formulary ID: 00021038
Formulary Version: 14
Contract Year: 2021
RXCUI: 242446
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 100129
Formulary ID: 00021038
Formulary Version: 14
Contract Year: 2021
RXCUI: 857700
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 300
Qty Limit Days: 30
ID: 100130
Formulary ID: 00021038
Formulary Version: 14
Contract Year: 2021
RXCUI: 213291
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0