CMS Formulary

Displaying 126791-126800 of 1611142 results.
ID: 126791
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1923426
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126792
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1923424
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126793
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 904589
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126794
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 894859
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126795
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 866042
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126796
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 855288
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126797
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 855302
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126798
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 855312
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126799
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 855318
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126800
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 855324
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0