CMS Formulary

Displaying 128541-128550 of 1611142 results.
ID: 128541
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2396774
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 14
Qty Limit Days: 28
ID: 128542
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1370982
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128543
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2123137
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 128544
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2123141
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128545
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2123145
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128546
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1102277
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128547
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 205918
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128548
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 205922
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128549
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 205924
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128550
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1721690
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0