CMS Formulary

Displaying 126541-126550 of 1611142 results.
ID: 126541
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 351266
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 126542
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 351267
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 126543
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 905172
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126544
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 905168
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126545
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 892589
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 3000
Qty Limit Days: 30
ID: 126546
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 894780
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1500
Qty Limit Days: 30
ID: 126547
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 997170
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 126548
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 997287
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 126549
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 997296
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 126550
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 310792
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30