CMS Formulary

Displaying 126251-126260 of 1611142 results.
ID: 126251
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 833008
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126252
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 883826
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126253
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1659929
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126254
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 2102705
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126255
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 2058906
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126256
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 2049133
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126257
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 2049121
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126258
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1365979
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126259
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1855072
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 126260
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1986331
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30