CMS Formulary

Displaying 125921-125930 of 1611142 results.
ID: 125921
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1490026
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 125922
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1490034
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 125923
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1490038
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 125924
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1597620
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125925
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 313580
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125926
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 859081
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 125927
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1486691
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125928
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1111020
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125929
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1653221
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 125930
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 311288
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0