CMS Formulary

Displaying 120381-120390 of 1611142 results.
ID: 120381
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 197366
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120382
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 197363
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120383
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 197364
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120384
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 197383
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120385
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 197382
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120386
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 805515
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 380
Qty Limit Days: 30
ID: 120387
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 603378
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 120388
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1190225
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 20
ID: 120389
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 580261
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 120390
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 836368
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0