CMS Formulary

Displaying 128751-128760 of 1611142 results.
ID: 128751
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1747697
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128752
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1741739
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128753
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1799218
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 28
Qty Limit Days: 28
ID: 128754
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2288816
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 56
Qty Limit Days: 28
ID: 128755
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1858267
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128756
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1939335
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128757
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1999673
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128758
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 831226
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128759
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 831255
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128760
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 831309
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0