CMS Formulary

Displaying 128911-128920 of 1611142 results.
ID: 128911
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1790886
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128912
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1790890
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128913
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2384465
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 5
Qty Limit Days: 28
ID: 128914
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1670324
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 128915
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1670322
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 300
Qty Limit Days: 30
ID: 128916
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1600774
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128917
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1600776
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128918
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1600915
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128919
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1600917
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128920
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1117531
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30