CMS Formulary

Displaying 128841-128850 of 1611142 results.
ID: 128841
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1364362
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128842
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1364358
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128843
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2473042
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128844
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2049271
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128845
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2049278
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128846
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 197518
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128847
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 284215
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128848
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1658221
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128849
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 544840
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128850
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 313165
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 6
Qty Limit Days: 30