CMS Formulary

Displaying 128741-128750 of 1611142 results.
ID: 128741
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1744003
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128742
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1744007
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128743
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1744011
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128744
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 901614
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128745
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1147337
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128746
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1306298
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128747
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1551999
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128748
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1544471
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128749
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1544475
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128750
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1721619
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30