CMS Formulary

Displaying 121081-121090 of 1611142 results.
ID: 121081
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 903847
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 121082
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1307061
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 121083
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1115698
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 780
Qty Limit Days: 30
ID: 121084
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1308569
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 121085
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 351209
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 121086
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 310362
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 121087
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 197623
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 121088
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1435115
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 121089
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1099808
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 121090
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1484296
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0