CMS Formulary

Displaying 128771-128780 of 1611142 results.
ID: 128771
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 311197
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128772
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 311196
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128773
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 317769
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128774
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 314208
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128775
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 312847
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128776
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 205284
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128777
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 205285
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128778
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 643019
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 128779
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 643022
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128780
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 866482
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0