CMS Formulary

Displaying 126931-126940 of 1611142 results.
ID: 126931
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 197408
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126932
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 197405
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126933
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 103401
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126934
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 706546
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126935
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 153095
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126936
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 197590
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 126937
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 197591
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 126938
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 197589
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 126939
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 197391
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 126940
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 197392
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0