CMS Formulary

Displaying 128051-128060 of 1611142 results.
ID: 128051
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 729201
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128052
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 729203
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 128053
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1796079
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128054
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1796083
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128055
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1433879
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128056
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1546894
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128057
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1857913
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 128058
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1857917
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128059
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1857925
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 1840
Qty Limit Days: 30
ID: 128060
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1989506
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30