CMS Formulary

Displaying 125771-125780 of 1611142 results.
ID: 125771
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 312087
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125772
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 198334
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125773
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 198335
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125774
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 979468
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 125775
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 979464
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 125776
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 979471
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 125777
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 198188
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 125778
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 313134
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125779
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 562508
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125780
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 861783
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30