CMS Formulary

Displaying 125301-125310 of 1611142 results.
ID: 125301
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 313142
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125302
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 312347
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125303
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1048450
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125304
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1048445
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125305
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 855626
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 125306
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1607617
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 125307
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 311345
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125308
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 198200
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125309
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 349514
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 125310
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 351256
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0