CMS Formulary

Displaying 125741-125750 of 1611142 results.
ID: 125741
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 313222
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125742
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 309076
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125743
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 309078
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125744
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 198352
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 125745
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 200031
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125746
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 200033
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125747
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 315223
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 12
Qty Limit Days: 30
ID: 125748
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 313161
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 12
Qty Limit Days: 30
ID: 125749
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 313160
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 12
Qty Limit Days: 30
ID: 125750
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 854873
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30