CMS Formulary

Displaying 128441-128450 of 1611142 results.
ID: 128441
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 858125
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128442
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 858127
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128443
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 197699
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128444
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 197700
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128445
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 596926
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 128446
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 596930
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128447
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 596934
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128448
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 308192
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128449
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 834061
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128450
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 834102
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0