CMS Formulary

Displaying 126391-126400 of 1611142 results.
ID: 126391
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 861663
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126392
Formulary ID: 00021051
Formulary Version: 15
Contract Year: 2021
RXCUI: 545278
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126393
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1551300
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 126394
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1551306
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 126395
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2058877
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 30
ID: 126396
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2395779
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 126397
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2058887
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 30
ID: 126398
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2370174
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 126399
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2170613
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 3
Qty Limit Days: 30
ID: 126400
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2395785
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28