CMS Formulary

Displaying 126901-126910 of 1611142 results.
ID: 126901
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 312036
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126902
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 856940
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 5400
Qty Limit Days: 30
ID: 126903
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 834137
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126904
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 810002
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 126905
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 809990
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 126906
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 809994
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 126907
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 809998
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 126908
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 995156
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 1200
Qty Limit Days: 30
ID: 126909
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 197604
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126910
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 197606
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0