CMS Formulary

Displaying 125021-125030 of 1611142 results.
ID: 125021
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 283535
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125022
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 198222
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125023
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 198150
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125024
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 96304
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125025
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 998689
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125026
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 998685
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125027
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 206791
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 30
ID: 125028
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 580286
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 125029
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1313785
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125030
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 207588
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0