CMS Formulary

Displaying 129691-129700 of 1611142 results.
ID: 129691
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 393245
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129692
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 885857
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129693
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 351265
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 129694
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 351266
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 129695
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 351267
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 129696
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 905172
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129697
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 905168
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129698
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 892589
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 3000
Qty Limit Days: 30
ID: 129699
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 894780
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1500
Qty Limit Days: 30
ID: 129700
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 997170
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30