CMS Formulary

Displaying 120471-120480 of 1611142 results.
ID: 120471
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 199119
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 120472
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1793916
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 6
Qty Limit Days: 30
ID: 120473
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1657173
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 6
Qty Limit Days: 30
ID: 120474
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1657160
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 6
Qty Limit Days: 30
ID: 120475
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1654630
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 120476
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 2000007
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 12
Qty Limit Days: 28
ID: 120477
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 309339
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120478
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 309335
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120479
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 309336
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120480
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 308207
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0