CMS Formulary

Displaying 126631-126640 of 1611142 results.
ID: 126631
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 616292
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 126632
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1357547
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 126633
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2048568
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 126634
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2102440
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126635
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2478437
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 300
Qty Limit Days: 30
ID: 126636
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2102456
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126637
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2099956
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 126638
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2058926
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 126639
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2102460
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126640
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2047602
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0