CMS Formulary

Displaying 120291-120300 of 1611142 results.
ID: 120291
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 577961
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 120292
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 541363
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 120293
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 404059
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120294
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 404062
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120295
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 643488
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120296
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 404065
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120297
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 751868
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120298
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 751871
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120299
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 751870
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120300
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 762007
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0