CMS Formulary

Displaying 126021-126030 of 1611142 results.
ID: 126021
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 205326
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 126022
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 646456
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 126023
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 310154
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126024
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 848768
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 30
ID: 126025
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1738511
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126026
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 205316
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126027
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 205315
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126028
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 313583
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126029
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 313585
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126030
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 992438
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0