CMS Formulary

Displaying 125561-125570 of 1611142 results.
ID: 125561
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 197443
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125562
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1099678
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125563
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1099870
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125564
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1356563
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 125565
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1356572
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 125566
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1356576
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 125567
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1356580
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 125568
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1356584
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 125569
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1356588
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 125570
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1790126
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 720
Qty Limit Days: 30