CMS Formulary

Displaying 128121-128130 of 1611142 results.
ID: 128121
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 198372
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128122
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 198369
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128123
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 198370
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128124
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1659803
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128125
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1242819
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 3
Qty Limit Days: 30
ID: 128126
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1242815
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 30
ID: 128127
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 616749
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128128
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 728231
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128129
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 477367
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128130
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 477372
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30