CMS Formulary

Displaying 129361-129370 of 1611142 results.
ID: 129361
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 199889
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129362
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 311486
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129363
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 904396
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 8
Qty Limit Days: 28
ID: 129364
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 199672
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 480
Qty Limit Days: 30
ID: 129365
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 239238
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129366
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 602393
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129367
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 432402
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 129368
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1373497
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129369
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 403875
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129370
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 310430
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0