CMS Formulary

Displaying 125151-125160 of 1611142 results.
ID: 125151
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 999967
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 125152
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 999996
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 125153
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 999986
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 125154
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1000001
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 125155
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 999991
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 125156
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 984082
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125157
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1654079
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125158
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 853354
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125159
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 853356
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125160
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1100075
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30