CMS Formulary

Displaying 125871-125880 of 1611142 results.
ID: 125871
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 647239
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 125872
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 198313
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125873
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 198312
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125874
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 352210
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125875
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 198175
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125876
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1490032
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 125877
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1490036
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 125878
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1490040
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 125879
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 351156
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125880
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1361615
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0