CMS Formulary

Displaying 129611-129620 of 1611142 results.
ID: 129611
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1235591
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 129612
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 668606
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129613
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 2055766
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129614
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1924315
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 129615
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1486841
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 129616
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 798300
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 1
ID: 129617
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 830253
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 0
Qty Limit Days: 1
ID: 129618
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 830245
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 1
ID: 129619
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 836636
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 999
ID: 129620
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 836634
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 999