CMS Formulary

Displaying 128901-128910 of 1611142 results.
ID: 128901
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1876673
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128902
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1876674
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128903
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 866111
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128904
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 198252
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128905
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1373489
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128906
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1373493
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128907
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1373498
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128908
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1040058
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128909
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 858804
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128910
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1790892
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30