CMS Formulary

Displaying 126431-126440 of 1611142 results.
ID: 126431
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 643175
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 126432
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 799830
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 126433
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1045408
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 126434
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1045404
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 126435
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1364441
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 126436
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1364447
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 126437
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 607579
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126438
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1598989
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 126439
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1601660
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 126440
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1992428
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 74
Qty Limit Days: 30