CMS Formulary

Displaying 124071-124080 of 1611142 results.
ID: 124071
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 238003
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 124072
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 403923
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 124073
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 198322
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124074
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 308962
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 124075
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 849395
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124076
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 991039
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124077
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 991194
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124078
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 991336
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124079
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 991044
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124080
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 991188
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0