CMS Formulary

Displaying 129821-129830 of 1611142 results.
ID: 129821
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1921240
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129822
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1921245
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129823
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1726846
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129824
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 847745
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 129825
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1872980
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129826
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1747577
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 129827
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1747579
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129828
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1747567
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 129829
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1747580
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129830
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1921017
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0