CMS Formulary

Displaying 122091-122100 of 1611142 results.
ID: 122091
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1373489
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 122092
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1373493
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 122093
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1373498
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 122094
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1040058
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 122095
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 858804
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 122096
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 794641
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 122097
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 902624
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 122098
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 902626
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 122099
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 617768
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 122100
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1790892
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30