CMS Formulary

Displaying 122261-122270 of 1611142 results.
ID: 122261
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 861375
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 122262
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 861370
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 122263
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1373745
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 122264
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1922783
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 122265
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 485442
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 122266
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 485465
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 122267
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1989085
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 224
Qty Limit Days: 28
ID: 122268
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 582595
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 210
Qty Limit Days: 30
ID: 122269
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 861966
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 122270
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1442143
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0