CMS Formulary

Displaying 128001-128010 of 1611142 results.
ID: 128001
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 805464
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 128002
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1659927
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128003
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 403878
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 128004
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2200174
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128005
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2200177
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128006
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2200180
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 128007
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2200183
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128008
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1648755
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128009
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 725021
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128010
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 725023
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30