CMS Formulary

Displaying 125851-125860 of 1611142 results.
ID: 125851
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 861654
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 125852
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 349591
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 125853
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 349592
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 125854
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 349593
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 125855
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1011736
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 125856
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1011739
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 125857
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 388311
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125858
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 200133
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125859
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 200131
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125860
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 896184
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30