CMS Formulary

Displaying 129831-129840 of 1611142 results.
ID: 129831
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1921010
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129832
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1921468
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129833
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 152971
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 480
Qty Limit Days: 30
ID: 129834
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1873087
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129835
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1940709
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 84
Qty Limit Days: 28
ID: 129836
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 835896
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129837
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 835835
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129838
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1115468
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129839
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1926069
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 30
ID: 129840
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1115259
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0