CMS Formulary

Displaying 126101-126110 of 1611142 results.
ID: 126101
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 855480
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126102
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 855474
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126103
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 749860
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126104
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 198373
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126105
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1094543
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126106
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 859033
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126107
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 859040
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126108
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 859052
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126109
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 855642
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126110
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 312504
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0