CMS Formulary

Displaying 124231-124240 of 1611142 results.
ID: 124231
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 199246
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 124232
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 199247
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 124233
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 314231
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 124234
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 312961
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 124235
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 198211
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 124236
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 200060
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124237
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 317573
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 124238
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 312440
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 124239
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 312441
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 124240
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 199123
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0