CMS Formulary

Displaying 126881-126890 of 1611142 results.
ID: 126881
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 856578
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126882
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 856556
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126883
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1870230
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 30
ID: 126884
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1870225
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 30
ID: 126885
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 242831
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126886
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 239239
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126887
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 856605
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126888
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 903857
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126889
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 856656
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126890
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 856660
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0