CMS Formulary

Displaying 128871-128880 of 1611142 results.
ID: 128871
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 730781
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128872
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1807632
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128873
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1795609
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128874
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1807552
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128875
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 861379
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128876
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 861383
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128877
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1743549
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128878
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1795477
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128879
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 581531
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128880
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2371050
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 150
Qty Limit Days: 30