CMS Formulary

Displaying 127161-127170 of 1611142 results.
ID: 127161
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 603206
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 127162
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 748961
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127163
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 751901
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127164
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 810096
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127165
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 749761
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127166
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 748868
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127167
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 759743
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127168
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1095224
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127169
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 748806
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127170
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 748804
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0