CMS Formulary

Displaying 126731-126740 of 1611142 results.
ID: 126731
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1425228
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126732
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1245003
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 126733
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 825425
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 126734
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 825429
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 126735
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 884619
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 126736
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2121061
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 126737
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1656356
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 126738
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1859501
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 126739
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1919094
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 126740
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2169314
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30