CMS Formulary

Displaying 126751-126760 of 1611142 results.
ID: 126751
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1801840
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 126752
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1923056
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 91
Qty Limit Days: 28
ID: 126753
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1923058
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 91
Qty Limit Days: 28
ID: 126754
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2002719
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 420
Qty Limit Days: 30
ID: 126755
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2058981
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 126756
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1298099
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126757
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 545293
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126758
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 207029
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126759
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 665022
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 600
Qty Limit Days: 30
ID: 126760
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1720881
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0