CMS Formulary

Displaying 128791-128800 of 1611142 results.
ID: 128791
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 861430
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128792
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 197939
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128793
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 197940
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128794
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 886662
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128795
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 886666
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128796
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 886671
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128797
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 686400
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128798
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1190572
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128799
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 835829
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128800
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 860975
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30