CMS Formulary

Displaying 124101-124110 of 1611142 results.
ID: 124101
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 854238
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 36
Qty Limit Days: 30
ID: 124102
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 854241
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 48
Qty Limit Days: 30
ID: 124103
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 854248
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 124104
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 854245
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 48
Qty Limit Days: 30
ID: 124105
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 854252
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 124106
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 406503
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124107
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 858262
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124108
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 310023
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124109
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 403890
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124110
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 197549
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0