CMS Formulary

Displaying 126281-126290 of 1611142 results.
ID: 126281
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 2119706
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126282
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 349287
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126283
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 313362
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126284
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 313364
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126285
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 313361
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126286
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 197558
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126287
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 197557
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126288
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 903843
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126289
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 2049884
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 126290
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 2265701
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30