CMS Formulary

Displaying 129771-129780 of 1611142 results.
ID: 129771
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 810075
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129772
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 810079
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129773
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 2284108
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129774
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 2099952
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 129775
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 2105860
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 129776
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 637188
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129777
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 795735
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129778
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 637190
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129779
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 795737
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129780
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 2284104
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30