CMS Formulary

Displaying 125901-125910 of 1611142 results.
ID: 125901
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 312743
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 125902
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 637173
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125903
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 312840
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 12
Qty Limit Days: 30
ID: 125904
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 314209
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 12
Qty Limit Days: 30
ID: 125905
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 199206
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125906
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 197805
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125907
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 197806
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125908
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 197807
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125909
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 311347
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 125910
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 311204
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30