CMS Formulary

Displaying 124491-124500 of 1611142 results.
ID: 124491
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 858747
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124492
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1542997
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 124493
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1432969
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 124494
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 904880
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 124495
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 891881
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 124496
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 891888
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 124497
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 891893
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 124498
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 891874
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 124499
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 892646
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 124500
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 848726
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30