CMS Formulary

Displaying 122521-122530 of 1611142 results.
ID: 122521
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 311753
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 122522
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1299897
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 122523
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 197891
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 122524
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 197892
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 122525
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 151029
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 122526
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 311265
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 122527
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 311264
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 122528
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 897649
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 122529
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 349594
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 122530
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 349595
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30