CMS Formulary

Displaying 128341-128350 of 1611142 results.
ID: 128341
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 828348
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128342
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1369831
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128343
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1304985
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128344
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1811182
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128345
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1716215
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128346
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1716219
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128347
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1716223
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128348
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1649405
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128349
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 313096
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128350
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 198224
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0