CMS Formulary

Displaying 129251-129260 of 1611142 results.
ID: 129251
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 314211
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129252
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 199890
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129253
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 845488
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 129254
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 861736
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 129255
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 861740
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 129256
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 577315
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129257
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 577317
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129258
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 836395
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 129259
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 198116
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129260
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 905158
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0