CMS Formulary

Displaying 128731-128740 of 1611142 results.
ID: 128731
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1667678
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128732
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1741747
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128733
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1809471
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128734
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1243346
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 128735
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1243326
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128736
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1243330
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128737
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1243229
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128738
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 404587
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128739
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 616148
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 850
Qty Limit Days: 30
ID: 128740
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 639888
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30