CMS Formulary

Displaying 129191-129200 of 1611142 results.
ID: 129191
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1650030
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129192
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 198201
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129193
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 728109
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 129194
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 312122
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 129195
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 833709
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129196
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 833711
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129197
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 833713
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129198
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 200346
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129199
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 308135
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129200
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 309054
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0