CMS Formulary

Displaying 125631-125640 of 1611142 results.
ID: 125631
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 2371050
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 150
Qty Limit Days: 30
ID: 125632
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 2371054
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 150
Qty Limit Days: 30
ID: 125633
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 2371058
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 150
Qty Limit Days: 30
ID: 125634
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 2371062
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 150
Qty Limit Days: 30
ID: 125635
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 2371066
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 150
Qty Limit Days: 30
ID: 125636
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1482513
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 125637
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1482517
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 125638
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1482523
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 125639
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1482527
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 125640
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1992571
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30