CMS Formulary

Displaying 122791-122800 of 1611142 results.
ID: 122791
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1594673
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 122792
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 905059
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 122793
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 905064
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 122794
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 905057
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 122795
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 198050
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 122796
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 198049
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 122797
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1251334
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 122798
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1368459
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 525
Qty Limit Days: 30
ID: 122799
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 751970
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 122800
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 2284516
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0