CMS Formulary

Displaying 127191-127200 of 1611142 results.
ID: 127191
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1091392
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 127192
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1091145
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 127193
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1091225
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 127194
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 897696
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 127195
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 897702
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 127196
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 897710
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 127197
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 864706
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 30
ID: 127198
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1049611
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 127199
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1049618
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 127200
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 245136
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 15
Qty Limit Days: 30