CMS Formulary

Displaying 120711-120720 of 1611142 results.
ID: 120711
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 863636
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 120712
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 863619
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 120713
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 863628
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 120714
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 314080
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120715
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1190655
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120716
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 545236
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120717
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1724340
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120718
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 312075
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120719
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 308345
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120720
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 197636
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0