CMS Formulary

Displaying 128641-128650 of 1611142 results.
ID: 128641
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 860107
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128642
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 904481
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128643
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 260218
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128644
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 205324
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128645
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 617312
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128646
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 617310
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128647
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 617311
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128648
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 310818
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128649
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 259255
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128650
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 205328
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0