CMS Formulary

Displaying 128551-128560 of 1611142 results.
ID: 128551
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 212219
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128552
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 213475
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128553
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 794610
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128554
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 831870
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128555
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 850457
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 128556
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1236632
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 400
Qty Limit Days: 30
ID: 128557
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1359271
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128558
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 758555
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128559
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1052660
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128560
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1250723
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30