CMS Formulary

Displaying 128701-128710 of 1611142 results.
ID: 128701
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 308720
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128702
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1605071
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128703
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1605075
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128704
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 314072
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128705
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 244967
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128706
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 309680
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128707
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 309679
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128708
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1376336
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128709
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 204874
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128710
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 313415
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0