CMS Formulary

Displaying 124791-124800 of 1611142 results.
ID: 124791
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 2054313
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 124792
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 2054316
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 124793
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 2054318
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 124794
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 312614
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124795
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 283077
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124796
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 993755
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4500
Qty Limit Days: 30
ID: 124797
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 197448
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124798
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1923432
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124799
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 477391
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124800
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 197877
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0