CMS Formulary

Displaying 129411-129420 of 1611142 results.
ID: 129411
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 199150
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 129412
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 311915
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129413
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1867544
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129414
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1725064
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129415
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1437713
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 129416
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1918242
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 129417
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1862595
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 129418
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1921589
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 129419
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1862590
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 129420
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 831246
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0