CMS Formulary

Displaying 127801-127810 of 1611142 results.
ID: 127801
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 200082
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 127802
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 199663
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 127803
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 905199
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127804
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 905225
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127805
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 905395
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127806
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 198371
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127807
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 197817
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127808
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 197818
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127809
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 197889
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127810
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 855172
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30