CMS Formulary

Displaying 127631-127640 of 1611142 results.
ID: 127631
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 861601
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127632
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 861597
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28
ID: 127633
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 615882
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127634
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 643070
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 127635
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 855926
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127636
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 855906
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127637
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 855664
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127638
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 995281
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127639
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1095227
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127640
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1304988
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0