CMS Formulary

Displaying 128171-128180 of 1611142 results.
ID: 128171
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 706831
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128172
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 706827
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128173
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 706829
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128174
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 706825
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128175
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 858074
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128176
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 858051
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128177
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 858057
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128178
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 858055
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128179
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 858053
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128180
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2059017
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30