CMS Formulary

Displaying 126601-126610 of 1611142 results.
ID: 126601
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 198146
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126602
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 207100
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126603
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 208821
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126604
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 351875
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126605
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1307630
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 126606
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1307635
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 126607
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1243010
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 126608
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1243014
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 126609
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1601394
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 126610
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1601386
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30