CMS Formulary

Displaying 121481-121490 of 1611142 results.
ID: 121481
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 313413
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 121482
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 314286
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 121483
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 313776
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 121484
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 313777
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 121485
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 313778
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 121486
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 313995
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 121487
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 314214
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 121488
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 312835
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 121489
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 314215
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 121490
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 312836
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30