CMS Formulary

Displaying 128201-128210 of 1611142 results.
ID: 128201
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1739788
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 600
Qty Limit Days: 30
ID: 128202
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1149617
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128203
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 213197
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128204
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 997010
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128205
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 866427
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128206
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 866412
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128207
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 866419
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128208
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1193341
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128209
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1193337
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128210
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1193345
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30