CMS Formulary

Displaying 120341-120350 of 1611142 results.
ID: 120341
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 314075
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120342
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 310812
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120343
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 861427
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120344
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 991086
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120345
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 314006
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 120346
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 315107
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 120347
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 310489
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 120348
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 250344
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120349
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 722122
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 120350
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 722116
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30