CMS Formulary

Displaying 125121-125130 of 1611142 results.
ID: 125121
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 197700
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125122
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 596926
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 125123
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 596930
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 125124
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 596934
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 125125
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 308192
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125126
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 834061
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125127
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 834102
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125128
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 310436
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 125129
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 310437
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 125130
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 579148
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30