CMS Formulary

Displaying 126611-126620 of 1611142 results.
ID: 126611
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1601390
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 126612
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1987734
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 126613
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2058922
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 126614
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2103175
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 126615
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2103179
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 126616
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2284108
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 126617
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2099952
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 126618
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2105860
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 126619
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 637188
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126620
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 795735
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0