CMS Formulary

Displaying 127791-127800 of 1611142 results.
ID: 127791
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 313761
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 127792
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 884173
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127793
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 884185
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127794
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 884189
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127795
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1099625
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127796
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 996571
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 127797
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 996561
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 127798
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 201708
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127799
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 248420
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 127800
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 199422
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30