CMS Formulary

Displaying 129131-129140 of 1611142 results.
ID: 129131
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 205305
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129132
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 409823
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129133
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 892582
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 129134
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 892672
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 129135
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1923822
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129136
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1923828
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129137
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1923826
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129138
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1490026
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 129139
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1490034
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 129140
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1490038
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30