CMS Formulary

Displaying 126661-126670 of 1611142 results.
ID: 126661
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 207088
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126662
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 855871
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126663
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1855527
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126664
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1921240
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126665
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1921245
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126666
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1726846
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126667
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 847745
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 126668
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1872980
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126669
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1747577
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 126670
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1747579
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30