CMS Formulary

Displaying 126681-126690 of 1611142 results.
ID: 126681
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1115468
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126682
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1926069
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 30
ID: 126683
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1115259
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126684
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1115459
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126685
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1115464
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126686
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1115473
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126687
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1946522
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126688
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 966271
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126689
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 727705
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126690
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1655728
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0