CMS Formulary

Displaying 126221-126230 of 1611142 results.
ID: 126221
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1744009
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 126222
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1243585
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126223
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 313988
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126224
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 309307
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126225
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1790684
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126226
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 197854
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126227
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 201912
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126228
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 310003
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126229
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 310004
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126230
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 310005
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0