CMS Formulary

Displaying 129701-129710 of 1611142 results.
ID: 129701
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 997287
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 129702
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 997296
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 129703
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 310792
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129704
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 310793
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129705
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 835589
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129706
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 477234
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129707
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 199519
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129708
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197624
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129709
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1437968
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129710
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1437969
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0