CMS Formulary

Displaying 126501-126510 of 1611142 results.
ID: 126501
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1595473
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126502
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1595478
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126503
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1595292
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126504
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1995479
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126505
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1595457
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126506
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 153579
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126507
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 153580
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126508
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 402092
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 126509
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 904170
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126510
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1859000
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 18
Qty Limit Days: 30