CMS Formulary

Displaying 124271-124280 of 1611142 results.
ID: 124271
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 197770
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124272
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 485023
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124273
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 309362
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 124274
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 198223
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124275
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 485020
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124276
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 856364
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124277
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 863636
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 124278
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 863619
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 124279
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 863628
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 124280
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 314080
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0