CMS Formulary

Displaying 129491-129500 of 1611142 results.
ID: 129491
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2382991
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 16
Qty Limit Days: 28
ID: 129492
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2382993
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 8
Qty Limit Days: 28
ID: 129493
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2272630
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 10
Qty Limit Days: 30
ID: 129494
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2272622
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 10
Qty Limit Days: 30
ID: 129495
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2272636
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 10
Qty Limit Days: 30
ID: 129496
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 2272624
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 10
Qty Limit Days: 30
ID: 129497
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 966153
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129498
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 966160
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129499
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 966166
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129500
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 966173
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0