CMS Formulary

Displaying 126701-126710 of 1611142 results.
ID: 126701
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 966205
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126702
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 966251
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126703
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 966218
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126704
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 835892
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126705
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 966185
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126706
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 212957
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126707
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2056897
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126708
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 746609
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 126709
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 845512
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126710
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 847734
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0