CMS Formulary

Displaying 128011-128020 of 1611142 results.
ID: 128011
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 311995
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128012
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1648759
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128013
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 903847
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128014
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1307061
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128015
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1115698
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 780
Qty Limit Days: 30
ID: 128016
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1308569
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128017
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 351209
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128018
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 310362
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128019
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 197623
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128020
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2055650
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0