CMS Formulary

Displaying 127251-127260 of 1611142 results.
ID: 127251
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1606490
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 127252
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 859983
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 127253
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 859979
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 127254
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1307309
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 127255
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2052609
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127256
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2052704
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127257
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2105817
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 127258
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1300797
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127259
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1300803
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127260
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 967388
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0