CMS Formulary

Displaying 122351-122360 of 1611142 results.
ID: 122351
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 892672
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 122352
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1923822
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 122353
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1923828
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 122354
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1923826
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 122355
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1490026
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 122356
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1490034
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 122357
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1490038
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 122358
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1597620
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 122359
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 313580
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 122360
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 859081
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30