CMS Formulary

Displaying 129031-129040 of 1611142 results.
ID: 129031
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 898353
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129032
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 898356
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129033
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 898359
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129034
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 898342
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129035
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 898346
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129036
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 562266
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129037
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 863669
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129038
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 313581
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129039
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 402246
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129040
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 402247
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30