CMS Formulary

Displaying 128041-128050 of 1611142 results.
ID: 128041
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1870207
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 30
ID: 128042
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1374574
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 128043
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2001430
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128044
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2003255
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128045
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2043464
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128046
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1246321
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 128047
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 865208
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128048
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 865212
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128049
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 865216
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128050
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 723827
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 1800
Qty Limit Days: 30