CMS Formulary

Displaying 128311-128320 of 1611142 results.
ID: 128311
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 856569
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128312
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 856460
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128313
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 856481
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128314
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 860654
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128315
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1014673
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128316
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 866144
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128317
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 199450
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128318
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 246172
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128319
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1606337
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128320
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 313498
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0