CMS Formulary

Displaying 129071-129080 of 1611142 results.
ID: 129071
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1652639
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129072
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 628958
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129073
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 861646
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129074
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 861650
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129075
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 861654
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129076
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 349591
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 129077
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 349592
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 129078
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 349593
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 129079
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1011736
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129080
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1011739
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30