CMS Formulary

Displaying 129481-129490 of 1611142 results.
ID: 129481
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 206902
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129482
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 483450
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 129483
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 483438
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 129484
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 483440
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 129485
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 483444
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 129486
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2178403
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 12
Qty Limit Days: 28
ID: 129487
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2178405
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 16
Qty Limit Days: 28
ID: 129488
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2382990
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 24
Qty Limit Days: 28
ID: 129489
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2178407
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 32
Qty Limit Days: 28
ID: 129490
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2178409
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 20
Qty Limit Days: 28