CMS Formulary

Displaying 122641-122650 of 1611142 results.
ID: 122641
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 728113
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 122642
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 483442
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 122643
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 483448
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 122644
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 483446
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 122645
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 312515
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 122646
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 310155
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 122647
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 315090
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 122648
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 310157
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 122649
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1795598
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 122650
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1366192
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 480
Qty Limit Days: 30