CMS Formulary

Displaying 126841-126850 of 1611142 results.
ID: 126841
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 476179
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 126842
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 476177
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 270
Qty Limit Days: 30
ID: 126843
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 199703
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126844
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1359129
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126845
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 899511
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126846
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 899439
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126847
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1006608
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126848
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 835894
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126849
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 835925
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126850
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 241834
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0