CMS Formulary

Displaying 129041-129050 of 1611142 results.
ID: 129041
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 664741
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129042
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 833528
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129043
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 309058
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129044
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 419849
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129045
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1800499
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129046
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1800500
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129047
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 992150
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129048
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 724863
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 129049
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 724859
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129050
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 724861
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30