CMS Formulary

Displaying 125801-125810 of 1611142 results.
ID: 125801
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 863669
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125802
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 313581
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125803
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 402246
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 125804
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 402247
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 125805
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 664741
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 125806
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 833528
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125807
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 722134
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 125808
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 722137
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 125809
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 722126
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 125810
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 722131
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30