CMS Formulary

Displaying 126451-126460 of 1611142 results.
ID: 126451
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1547118
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 126452
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1235595
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 126453
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1235591
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 126454
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 668606
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126455
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2055766
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 126456
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1924315
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 126457
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1486841
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 126458
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 798300
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 1
ID: 126459
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 830253
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 0
Qty Limit Days: 1
ID: 126460
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 830245
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 1