CMS Formulary

Displaying 128411-128420 of 1611142 results.
ID: 128411
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 966188
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128412
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 966410
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128413
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 966197
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128414
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 966399
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128415
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 966208
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128416
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 966214
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128417
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 352044
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128418
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 352045
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128419
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 352046
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128420
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 352047
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0