CMS Formulary

Displaying 129811-129820 of 1611142 results.
ID: 129811
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1148502
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129812
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 2168540
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129813
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1313887
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129814
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 855673
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129815
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 207331
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129816
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 207346
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129817
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 207361
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129818
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 207088
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129819
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 855871
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129820
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1855527
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0