CMS Formulary

Displaying 120081-120090 of 1611142 results.
ID: 120081
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 198324
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120082
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 198325
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120083
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 198323
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120084
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 855942
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120085
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 855863
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120086
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 313366
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120087
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1000070
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120088
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1536586
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120089
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 242333
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 120090
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 241527
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28