CMS Formulary

Displaying 120251-120260 of 1611142 results.
ID: 120251
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 309844
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 120252
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 865117
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120253
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 865123
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120254
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 860918
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120255
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 859841
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120256
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 313159
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 12
Qty Limit Days: 30
ID: 120257
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 197516
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120258
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 197517
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120259
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 996740
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 300
Qty Limit Days: 30
ID: 120260
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 311369
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 320
Qty Limit Days: 30