CMS Formulary

Displaying 120091-120100 of 1611142 results.
ID: 120091
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 403922
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 120092
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 402109
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 120093
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 855875
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120094
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 834235
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120095
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 834241
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120096
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1000076
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120097
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1000097
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120098
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 830865
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120099
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 830869
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120100
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 830872
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0