CMS Formulary

Displaying 126831-126840 of 1611142 results.
ID: 126831
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 429212
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126832
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 309374
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126833
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1299917
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126834
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 995218
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126835
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 866090
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126836
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 643066
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 126837
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1652084
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126838
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1006801
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 126839
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 996921
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 126840
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 721773
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30