CMS Formulary

Displaying 128951-128960 of 1611142 results.
ID: 128951
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 197745
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128952
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 197746
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128953
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 198358
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128954
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1099569
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128955
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1244214
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128956
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 485496
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 750
Qty Limit Days: 30
ID: 128957
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 348719
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 300
Qty Limit Days: 30
ID: 128958
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2183131
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 128959
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 825134
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 128960
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1801519
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30