CMS Formulary

Displaying 125261-125270 of 1611142 results.
ID: 125261
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 205918
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125262
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 205922
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125263
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 205924
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125264
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1721690
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125265
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 212219
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125266
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 213475
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125267
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 794610
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 125268
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 831870
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 125269
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 850457
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 125270
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1236632
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 400
Qty Limit Days: 30