CMS Formulary

Displaying 120581-120590 of 1611142 results.
ID: 120581
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 899548
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 120582
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1091133
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 900
Qty Limit Days: 30
ID: 120583
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 863664
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120584
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1012017
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120585
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 209002
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120586
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 208420
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120587
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 2055676
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120588
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 2055672
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120589
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1010603
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 120590
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1307058
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30