CMS Formulary

Displaying 126061-126070 of 1611142 results.
ID: 126061
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 905158
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126062
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 199376
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126063
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 199381
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126064
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 898490
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126065
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 686429
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 126066
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 314142
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 126067
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 311919
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 126068
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1988308
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126069
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1988311
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126070
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1988316
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0