CMS Formulary

Displaying 126551-126560 of 1611142 results.
ID: 126551
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 310793
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 126552
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 835589
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126553
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 477234
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126554
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 199519
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126555
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 197624
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126556
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1437968
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126557
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1437969
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126558
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 897657
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 1500
Qty Limit Days: 30
ID: 126559
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 977860
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126560
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1049604
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 3900
Qty Limit Days: 30