CMS Formulary

Displaying 129351-129360 of 1611142 results.
ID: 129351
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2265735
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129352
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 877417
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129353
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1809643
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129354
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1809499
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129355
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1664463
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129356
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1664440
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129357
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1664458
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129358
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1495070
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129359
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 199888
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129360
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 151226
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0