CMS Formulary

Displaying 128211-128220 of 1611142 results.
ID: 128211
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1193349
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128212
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1193353
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128213
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2359344
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128214
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2359348
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128215
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2359340
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128216
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2361300
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 30
ID: 128217
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2361296
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 128218
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1243052
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128219
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1606866
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128220
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1606870
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30