CMS Formulary

Displaying 128491-128500 of 1611142 results.
ID: 128491
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1300378
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 0
Qty Limit Days: 1
ID: 128492
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1300370
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 0
Qty Limit Days: 1
ID: 128493
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 805579
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 1
ID: 128494
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 901518
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 1
ID: 128495
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 830463
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 1
ID: 128496
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1601407
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 0
Qty Limit Days: 1
ID: 128497
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2110618
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128498
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1114074
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128499
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1114096
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128500
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1114470
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30