CMS Formulary

Displaying 129711-129720 of 1611142 results.
ID: 129711
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 897657
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 1500
Qty Limit Days: 30
ID: 129712
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1049604
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 3900
Qty Limit Days: 30
ID: 129713
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1874559
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129714
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1874553
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 129715
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 900575
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 30
ID: 129716
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 977427
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129717
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 977434
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129718
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 977438
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129719
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1304979
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129720
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 892625
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 300
Qty Limit Days: 30