CMS Formulary

Displaying 124301-124310 of 1611142 results.
ID: 124301
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 861010
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 124302
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 861004
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 75
Qty Limit Days: 30
ID: 124303
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 861731
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 124304
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 562524
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124305
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1652673
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124306
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1649429
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124307
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1650142
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124308
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 353538
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124309
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1723156
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124310
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 897666
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0