CMS Formulary

Displaying 126521-126530 of 1611142 results.
ID: 126521
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 688242
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126522
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 205739
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126523
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 208513
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 126524
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 404550
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 126525
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 150840
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 126526
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 208949
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 126527
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 202301
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 126528
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1000491
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 126529
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1000497
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 126530
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1000499
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30