CMS Formulary

Displaying 129121-129130 of 1611142 results.
ID: 129121
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 314209
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 12
Qty Limit Days: 30
ID: 129122
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 199206
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129123
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 197805
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129124
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 197806
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129125
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 197807
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129126
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 311347
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 129127
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 311204
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 129128
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 898715
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 900
Qty Limit Days: 30
ID: 129129
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 282755
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129130
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 205304
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30