CMS Formulary

Displaying 121701-121710 of 1611142 results.
ID: 121701
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 794610
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 121702
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 831870
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 121703
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 850457
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 121704
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1236632
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 400
Qty Limit Days: 30
ID: 121705
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1359271
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 121706
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 758555
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 121707
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1052660
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 121708
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1250723
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 121709
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1600710
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 121710
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1999587
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30