CMS Formulary

Displaying 129161-129170 of 1611142 results.
ID: 129161
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 307650
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 129162
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 309097
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129163
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 309098
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129164
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 835572
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129165
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 835591
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129166
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 835577
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129167
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 312940
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129168
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 309080
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129169
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 309081
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129170
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 197452
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0