CMS Formulary

Displaying 129431-129440 of 1611142 results.
ID: 129431
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1855072
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 129432
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1986331
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129433
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1918230
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129434
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2054269
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 28
Qty Limit Days: 28
ID: 129435
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 432400
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 129436
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1940654
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 129437
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1921081
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 30
ID: 129438
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1866047
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129439
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1099026
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129440
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1099269
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0