CMS Formulary

Displaying 125141-125150 of 1611142 results.
ID: 125141
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 313586
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125142
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 311759
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 125143
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 866511
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125144
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 866514
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125145
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 476809
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125146
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 197499
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125147
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 197500
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125148
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 198105
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125149
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 198104
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125150
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1662285
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0