CMS Formulary

Displaying 125311-125320 of 1611142 results.
ID: 125311
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 351257
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125312
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 310261
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125313
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 308459
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125314
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 141963
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125315
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 309332
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 75
Qty Limit Days: 30
ID: 125316
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 197519
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125317
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1000126
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125318
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1000153
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125319
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 198232
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125320
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 311727
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0