CMS Formulary

Displaying 126491-126500 of 1611142 results.
ID: 126491
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 762849
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126492
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 762852
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126493
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 762859
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126494
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 762868
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126495
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 762897
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126496
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1011987
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126497
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1000089
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126498
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1190955
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 126499
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1190957
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 126500
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1595462
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0