CMS Formulary

Displaying 120771-120780 of 1611142 results.
ID: 120771
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 314165
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120772
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 226343
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120773
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1191013
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120774
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 308493
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120775
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1116150
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120776
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 310594
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120777
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 754512
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120778
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 905379
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 120779
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 686405
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120780
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 863603
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0