CMS Formulary

Displaying 121271-121280 of 1611142 results.
ID: 121271
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1739766
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 121272
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1739774
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 121273
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 2173500
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 10
Qty Limit Days: 30
ID: 121274
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1739778
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 121275
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1739782
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 121276
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1739770
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 121277
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1251914
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 121278
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 722256
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 121279
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1251918
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 121280
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 724142
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0