CMS Formulary

Displaying 125421-125430 of 1611142 results.
ID: 125421
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 966241
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125422
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 966243
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125423
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1049223
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 30
ID: 125424
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1049227
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 30
ID: 125425
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1049216
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 30
ID: 125426
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 854801
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125427
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 313477
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125428
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 861200
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125429
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1000647
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125430
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1000862
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0