CMS Formulary

Displaying 126671-126680 of 1611142 results.
ID: 126671
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1747567
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 126672
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1747580
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126673
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1921017
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126674
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1921010
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126675
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1921468
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126676
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 152971
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 480
Qty Limit Days: 30
ID: 126677
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1873087
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126678
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1940709
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 84
Qty Limit Days: 28
ID: 126679
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 835896
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126680
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 835835
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0