CMS Formulary

Displaying 128231-128240 of 1611142 results.
ID: 128231
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 904158
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128232
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 309370
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128233
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 103457
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128234
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 197407
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128235
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 310364
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128236
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 238920
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128237
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 204135
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128238
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1370754
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128239
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1370750
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128240
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 203088
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30