CMS Formulary

Displaying 128381-128390 of 1611142 results.
ID: 128381
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1099563
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128382
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 904932
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28
ID: 128383
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 313758
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128384
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 199655
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128385
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 349208
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128386
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 360110
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128387
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 206913
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128388
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 206917
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128389
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1657151
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 6
Qty Limit Days: 30
ID: 128390
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 749206
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0