CMS Formulary

Displaying 120141-120150 of 1611142 results.
ID: 120141
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 577057
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 15
Qty Limit Days: 30
ID: 120142
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 2110510
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 120143
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 2110513
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 120144
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 2110516
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 120145
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 886634
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 5
Qty Limit Days: 30
ID: 120146
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1437702
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120147
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 857002
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 30
ID: 120148
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 857005
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 30
ID: 120149
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 856999
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 30
ID: 120150
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 993781
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 390
Qty Limit Days: 30