CMS Formulary

Displaying 119291-119300 of 1611142 results.
ID: 119291
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 106892
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 119292
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 847254
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 119293
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 847213
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 119294
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1652640
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 119295
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 847189
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 119296
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 847199
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 119297
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1731317
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 119298
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 643177
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 119299
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 643173
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 119300
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 643175
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30