CMS Formulary

Displaying 129111-129120 of 1611142 results.
ID: 129111
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 308136
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129112
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 197361
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129113
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 310432
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129114
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 311880
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129115
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 317174
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 129116
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 312745
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 129117
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 616483
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 129118
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 312743
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 129119
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 637173
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129120
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 312840
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 12
Qty Limit Days: 30