CMS Formulary

Displaying 124391-124400 of 1611142 results.
ID: 124391
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 152695
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124392
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 854905
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124393
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 854901
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124394
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 313762
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 124395
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 313761
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 124396
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 884173
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124397
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 884185
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124398
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 884189
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124399
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1099625
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124400
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 996571
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30