CMS Formulary

Displaying 128091-128100 of 1611142 results.
ID: 128091
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 250820
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 128092
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 858751
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128093
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 858733
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128094
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 848943
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128095
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1801279
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128096
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1486687
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128097
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 197797
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128098
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 197726
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128099
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1653217
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128100
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 860225
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0