CMS Formulary

Displaying 125251-125260 of 1611142 results.
ID: 125251
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 2396770
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 14
Qty Limit Days: 28
ID: 125252
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 2396774
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 14
Qty Limit Days: 28
ID: 125253
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 727816
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28
ID: 125254
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1650901
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28
ID: 125255
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1370982
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 125256
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 809477
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 125257
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 2123137
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 125258
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 2123141
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 125259
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 2123145
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 125260
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1102277
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30