CMS Formulary

Displaying 129391-129400 of 1611142 results.
ID: 129391
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1796922
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129392
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 311913
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129393
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1744001
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129394
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1744005
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129395
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1744009
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129396
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1243585
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129397
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 313988
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129398
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 309307
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129399
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1790684
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129400
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 201912
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0