CMS Formulary

Displaying 121251-121260 of 1611142 results.
ID: 121251
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 207059
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 15
Qty Limit Days: 30
ID: 121252
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 211140
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 121253
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 706831
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 121254
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 706827
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 121255
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 706829
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 121256
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 706825
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 121257
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 858074
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 121258
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 858051
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 121259
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 858057
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 121260
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 858055
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0