CMS Formulary

Displaying 129091-129100 of 1611142 results.
ID: 129091
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 352210
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129092
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 198175
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129093
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1490032
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 129094
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1490036
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 129095
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1490040
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 129096
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 351156
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129097
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1361615
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129098
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1361226
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129099
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 861363
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129100
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 861365
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0