CMS Formulary

Displaying 125051-125060 of 1611142 results.
ID: 125051
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 313778
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 125052
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 313995
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125053
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 314214
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 125054
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 312835
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 125055
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 314215
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 125056
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 312836
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 125057
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 311277
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 125058
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1099563
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125059
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 904932
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28
ID: 125060
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 313758
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30