CMS Formulary

Displaying 126651-126660 of 1611142 results.
ID: 126651
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2168548
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 126652
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2058932
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 126653
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1148506
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126654
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1148502
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126655
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2168540
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 126656
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1313887
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126657
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 855673
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126658
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 207331
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126659
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 207346
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126660
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 207361
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0