CMS Formulary

Displaying 125661-125670 of 1611142 results.
ID: 125661
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 858804
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 125662
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 794641
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 125663
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 902624
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 125664
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 902626
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 125665
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 617768
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 125666
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1790892
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 125667
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1790886
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 125668
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1790890
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 125669
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 2384465
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 5
Qty Limit Days: 28
ID: 125670
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1670324
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30