CMS Formulary

Displaying 125111-125120 of 1611142 results.
ID: 125111
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1046402
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125112
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1649491
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 125113
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1649495
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 125114
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 2168596
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 450
Qty Limit Days: 30
ID: 125115
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 2045638
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 30
ID: 125116
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 2120195
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 30
ID: 125117
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1991509
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125118
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 858125
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125119
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 858127
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125120
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 197699
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0