CMS Formulary

Displaying 120861-120870 of 1611142 results.
ID: 120861
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 200094
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 120862
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 200095
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 120863
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 200096
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 120864
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 197311
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120865
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 197313
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120866
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 313566
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 120867
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 485434
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120868
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 485436
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 120869
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 859424
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 120870
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 859747
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30