CMS Formulary

Displaying 129731-129740 of 1611142 results.
ID: 129731
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 864761
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 3600
Qty Limit Days: 30
ID: 129732
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 864769
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1800
Qty Limit Days: 30
ID: 129733
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 205301
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129734
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 315187
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129735
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 856724
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129736
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 856733
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129737
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 309371
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129738
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197577
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129739
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 343033
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129740
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197579
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0