CMS Formulary

Displaying 127931-127940 of 1611142 results.
ID: 127931
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 198040
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127932
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1010600
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 127933
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1307056
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 127934
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1010604
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 127935
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 198182
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127936
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 351223
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127937
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 401938
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127938
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2477272
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 127939
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1809520
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127940
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 239189
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0