CMS Formulary

Displaying 122241-122250 of 1611142 results.
ID: 122241
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 722134
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 122242
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 722137
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 122243
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 722126
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 122244
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 722131
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 122245
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 860715
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 122246
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 860695
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 122247
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 860707
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 122248
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 309058
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 122249
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 419849
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 122250
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1800499
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0