CMS Formulary

Displaying 127091-127100 of 1611142 results.
ID: 127091
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1298857
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127092
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 197464
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 127093
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1298861
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127094
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1298870
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127095
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 314034
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127096
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 198284
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127097
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 310671
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127098
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 310670
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127099
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1373483
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 127100
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1373491
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30