CMS Formulary

Displaying 128861-128870 of 1611142 results.
ID: 128861
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 204509
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128862
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 312069
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128863
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 312070
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128864
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1722919
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128865
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1722921
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128866
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1117522
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128867
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1664981
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128868
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 859871
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128869
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 204416
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128870
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1722934
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0