CMS Formulary

Displaying 128301-128310 of 1611142 results.
ID: 128301
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 831533
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128302
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1359134
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128303
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 312138
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128304
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 312839
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 12
Qty Limit Days: 30
ID: 128305
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 312837
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 12
Qty Limit Days: 30
ID: 128306
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1359127
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128307
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1359124
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128308
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 403884
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128309
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 310599
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128310
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 856535
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0