CMS Formulary

Displaying 128431-128440 of 1611142 results.
ID: 128431
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 731229
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128432
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 727542
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128433
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 993456
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 180
ID: 128434
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1046402
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128435
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1649491
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128436
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1649495
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128437
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2168596
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 450
Qty Limit Days: 30
ID: 128438
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2045638
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 30
ID: 128439
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2120195
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 30
ID: 128440
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1991509
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0