CMS Formulary

Displaying 125371-125380 of 1611142 results.
ID: 125371
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 617310
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 125372
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 617311
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 125373
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 310818
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125374
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 259255
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 125375
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 577208
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 125376
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 205328
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125377
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 314155
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 125378
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 351107
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 125379
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 859193
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125380
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 686379
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30