CMS Formulary

Displaying 120161-120170 of 1611142 results.
ID: 120161
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 864706
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 30
ID: 120162
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1049611
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 120163
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1049618
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 120164
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 884535
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 120165
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 884532
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 120166
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 245136
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 15
Qty Limit Days: 30
ID: 120167
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 245134
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 15
Qty Limit Days: 30
ID: 120168
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 245135
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 15
Qty Limit Days: 30
ID: 120169
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 197696
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 15
Qty Limit Days: 30
ID: 120170
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1870650
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0