CMS Formulary

Displaying 125131-125140 of 1611142 results.
ID: 125131
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 104894
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125132
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 861132
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125133
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 310352
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125134
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 310353
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125135
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 200257
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 960
Qty Limit Days: 30
ID: 125136
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 200256
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 480
Qty Limit Days: 30
ID: 125137
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 200258
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 125138
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 313582
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125139
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 313584
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125140
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 314277
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0