CMS Formulary

Displaying 124901-124910 of 1611142 results.
ID: 124901
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 848208
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124902
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 848176
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124903
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 848178
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124904
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 312139
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 124905
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 896110
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124906
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1191310
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124907
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1246096
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124908
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 313200
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124909
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 103456
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 124910
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 310891
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0