CMS Formulary

Displaying 122491-122500 of 1611142 results.
ID: 122491
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 836395
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 122492
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 198116
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 122493
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 349253
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 122494
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 656659
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 122495
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 905158
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 122496
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 199376
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 122497
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 199381
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 122498
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 898490
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 122499
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 686429
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 122500
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 314142
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30