CMS Formulary

Displaying 16121-16130 of 1611142 results.
ID: 16121
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 2049121
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 16122
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1855072
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 16123
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1986331
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 16124
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1918230
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 16125
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 2054269
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 16126
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 432400
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 16127
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1940654
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 16128
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1944382
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 16129
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1944376
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 16130
Formulary ID: 00021004
Formulary Version: 14
Contract Year: 2021
RXCUI: 1921081
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 30