CMS Formulary

Displaying 126571-126580 of 1611142 results.
ID: 126571
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 313932
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126572
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 309843
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126573
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1190568
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126574
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1797907
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126575
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 197730
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126576
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 197731
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126577
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 756059
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126578
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 311376
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 150
Qty Limit Days: 30
ID: 126579
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 864761
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 3600
Qty Limit Days: 30
ID: 126580
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 864769
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1800
Qty Limit Days: 30