CMS Formulary

Displaying 128651-128660 of 1611142 results.
ID: 128651
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 314155
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128652
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 351107
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128653
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 859193
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128654
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1665050
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128655
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1665093
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128656
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1665088
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128657
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1665046
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128658
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 310467
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128659
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 860103
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128660
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 310377
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0