CMS Formulary

Displaying 120111-120120 of 1611142 results.
ID: 120111
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1918042
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 120112
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1111641
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 120113
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1487361
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 12
Qty Limit Days: 28
ID: 120114
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 351137
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120115
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 351136
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120116
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1855389
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120117
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 728550
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 100
Qty Limit Days: 28
ID: 120118
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 199689
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120119
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 603208
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 120120
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 603203
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30