CMS Formulary

Displaying 129671-129680 of 1611142 results.
ID: 129671
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1797880
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129672
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 207370
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129673
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 706467
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129674
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 688242
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129675
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 205739
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129676
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 208513
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129677
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 404550
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129678
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 150840
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129679
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 208949
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129680
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 202301
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30