CMS Formulary

Displaying 125681-125690 of 1611142 results.
ID: 125681
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 313428
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125682
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 242680
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 960
Qty Limit Days: 30
ID: 125683
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 205292
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 125684
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 205290
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 125685
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 315134
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125686
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 866021
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125687
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1992303
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125688
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 427163
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125689
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 313123
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125690
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 198013
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0