CMS Formulary

Displaying 128081-128090 of 1611142 results.
ID: 128081
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 860215
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128082
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 860221
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128083
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 198056
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 128084
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 351276
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128085
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 349194
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 128086
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 349195
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 128087
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 349198
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 128088
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 403825
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128089
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 312439
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128090
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 198103
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0