CMS Formulary

Displaying 124151-124160 of 1611142 results.
ID: 124151
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 209002
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124152
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 208420
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124153
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 2055676
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124154
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 2055672
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124155
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1010603
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 124156
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1307058
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 124157
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1010606
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 124158
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1307063
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 124159
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 314111
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124160
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 858798
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 150
Qty Limit Days: 30