CMS Formulary

Displaying 127291-127300 of 1611142 results.
ID: 127291
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 310497
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127292
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 905369
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127293
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 311166
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127294
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 197832
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127295
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 349196
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 127296
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 349197
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 300
Qty Limit Days: 30
ID: 127297
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 905516
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127298
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 905495
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127299
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 835913
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127300
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1000405
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0