CMS Formulary

Displaying 120671-120680 of 1611142 results.
ID: 120671
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 317573
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 120672
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 312440
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 120673
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 312441
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 120674
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 199123
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120675
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 197956
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120676
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 197958
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120677
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 200064
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120678
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 199224
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120679
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 313190
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120680
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 198377
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0