CMS Formulary

Displaying 119721-119730 of 1611142 results.
ID: 119721
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 197596
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 119722
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 753543
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 119723
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 2110455
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 119724
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1918209
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 30
ID: 119725
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1918194
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 30
ID: 119726
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1918203
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 30
ID: 119727
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 904870
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 119728
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 904876
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 119729
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 312594
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 119730
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 198141
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0