CMS Formulary

Displaying 129581-129590 of 1611142 results.
ID: 129581
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 847213
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129582
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1652640
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129583
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 847189
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129584
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 847199
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129585
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1731317
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129586
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 643177
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129587
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 643173
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 129588
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 643175
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 129589
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 799830
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129590
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1045408
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30