CMS Formulary

Displaying 127541-127550 of 1611142 results.
ID: 127541
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 855300
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127542
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1809730
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127543
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1809738
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127544
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1233711
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127545
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 854228
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 18
Qty Limit Days: 30
ID: 127546
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 854235
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 24
Qty Limit Days: 30
ID: 127547
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 854238
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 36
Qty Limit Days: 30
ID: 127548
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 854241
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 48
Qty Limit Days: 30
ID: 127549
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 854248
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 127550
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 854245
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 48
Qty Limit Days: 30