CMS Formulary

Displaying 126781-126790 of 1611142 results.
ID: 126781
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 198046
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126782
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 198047
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126783
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 312059
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126784
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 866018
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126785
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 603103
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126786
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 106346
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 110
Qty Limit Days: 30
ID: 126787
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1098649
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126788
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1098670
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126789
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1098674
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126790
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1923422
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0