CMS Formulary

Displaying 121-130 of 1611142 results.
ID: 121
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 861637
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 122
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 861206
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 123
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 904170
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 854859
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 1859000
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 126
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 1604544
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 13
Qty Limit Days: 28
ID: 127
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 2002420
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 18
Qty Limit Days: 28
ID: 128
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 1923338
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 1923347
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 1876406
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0