CMS Formulary

Displaying 129601-129610 of 1611142 results.
ID: 129601
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 213284
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129602
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 859865
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 129603
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 404460
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 129604
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1593140
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 0
Qty Limit Days: 1
ID: 129605
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1547575
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129606
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1547110
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129607
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 744846
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 129608
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1547114
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129609
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1547118
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129610
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1235595
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30