CMS Formulary

Displaying 125711-125720 of 1611142 results.
ID: 125711
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1099569
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125712
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1244214
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125713
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 197312
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 125714
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 485496
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 750
Qty Limit Days: 30
ID: 125715
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 348719
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 300
Qty Limit Days: 30
ID: 125716
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 2183131
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 125717
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 825134
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 125718
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1801519
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 125719
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 539789
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125720
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 856666
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0