CMS Formulary

Displaying 122821-122830 of 1611142 results.
ID: 122821
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 1992305
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 122822
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 644304
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 122823
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 861659
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 122824
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 861661
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 122825
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 861663
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 122826
Formulary ID: 00021049
Formulary Version: 16
Contract Year: 2021
RXCUI: 545278
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 122827
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1551300
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 122828
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1551306
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 122829
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 2058877
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 30
ID: 122830
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 2395779
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28