CMS Formulary

Displaying 129001-129010 of 1611142 results.
ID: 129001
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 979485
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 129002
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 979492
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 129003
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 979480
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129004
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 248109
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129005
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 314108
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129006
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 311290
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129007
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 904431
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 129008
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 312087
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129009
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 198334
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129010
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 198335
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0