CMS Formulary

Displaying 126481-126490 of 1611142 results.
ID: 126481
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1549454
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 126482
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 205562
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126483
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 848330
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126484
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 763489
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126485
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 996559
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126486
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 762833
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126487
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 762836
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126488
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 762839
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126489
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 762843
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126490
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 762875
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0