CMS Formulary

Displaying 126191-126200 of 1611142 results.
ID: 126191
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 403875
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 126192
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 310430
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126193
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 310459
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126194
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 828320
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126195
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 314285
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126196
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 198006
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126197
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 198007
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126198
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 198008
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126199
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 200311
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126200
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 310431
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0