CMS Formulary

Displaying 127131-127140 of 1611142 results.
ID: 127131
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 313366
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127132
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1000070
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127133
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 242333
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 127134
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 241527
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 127135
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 403922
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 127136
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 402109
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 127137
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 855875
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127138
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 834235
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127139
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 834241
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127140
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 359144
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0