CMS Formulary

Displaying 127021-127030 of 1611142 results.
ID: 127021
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 207273
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127022
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1437709
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127023
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2001321
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 127024
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1091843
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 127025
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 402091
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 127026
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1986819
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 127027
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2289424
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 127028
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2289428
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 127029
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1942485
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 127030
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1942489
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30