CMS Formulary

Displaying 127151-127160 of 1611142 results.
ID: 127151
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 404061
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127152
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 404064
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127153
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1918042
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 127154
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1111641
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 127155
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1487361
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 12
Qty Limit Days: 28
ID: 127156
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 351137
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127157
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 351136
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127158
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 199689
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127159
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 603208
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 127160
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 603203
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30