CMS Formulary

Displaying 124141-124150 of 1611142 results.
ID: 124141
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 2101899
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124142
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1049683
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 30
ID: 124143
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1049686
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 124144
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1091150
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 124145
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 899557
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 124146
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 899518
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 124147
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 899548
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 124148
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1091133
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 900
Qty Limit Days: 30
ID: 124149
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 863664
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124150
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1012017
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0