CMS Formulary

Displaying 124551-124560 of 1611142 results.
ID: 124551
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 198040
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124552
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1010600
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 124553
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1307056
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 124554
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1010604
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 124555
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 198182
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124556
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 351223
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124557
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 401938
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124558
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 758032
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 6
Qty Limit Days: 28
ID: 124559
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 758027
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 6
Qty Limit Days: 28
ID: 124560
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1650282
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28