CMS Formulary

Displaying 128631-128640 of 1611142 results.
ID: 128631
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 903887
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128632
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 903891
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128633
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 903884
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128634
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 242446
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128635
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 213291
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128636
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1111339
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128637
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 860805
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128638
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1111343
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128639
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 313919
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 3
Qty Limit Days: 28
ID: 128640
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1797867
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0