CMS Formulary

Displaying 126261-126270 of 1611142 results.
ID: 126261
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1918230
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 126262
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 2054269
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 28
Qty Limit Days: 28
ID: 126263
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 432400
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 126264
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1940654
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 126265
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1921081
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 30
ID: 126266
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1866047
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126267
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1099026
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126268
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1099269
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126269
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1006065
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126270
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 1020155
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0