CMS Formulary

Displaying 120501-120510 of 1611142 results.
ID: 120501
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 142046
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120502
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 244374
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120503
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 238004
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 120504
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 313921
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120505
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 238003
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 120506
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 403923
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 120507
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 198322
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120508
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 308962
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 120509
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 849395
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120510
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 991039
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0