CMS Formulary

Displaying 128481-128490 of 1611142 results.
ID: 128481
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 829989
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 0
Qty Limit Days: 1
ID: 128482
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 830552
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 0
Qty Limit Days: 1
ID: 128483
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 830557
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 0
Qty Limit Days: 1
ID: 128484
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 803371
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 1
ID: 128485
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1300810
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 1
ID: 128486
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 798430
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 0
Qty Limit Days: 1
ID: 128487
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 798428
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 1
ID: 128488
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1986830
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 1
ID: 128489
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 798482
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 999
ID: 128490
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 798479
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 999