CMS Formulary

Displaying 129971-129980 of 1611142 results.
ID: 129971
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 617316
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129972
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 617296
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129973
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 636664
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129974
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 608328
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129975
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1148141
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 270
Qty Limit Days: 30
ID: 129976
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 861960
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129977
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197595
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129978
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197596
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129979
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 753543
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129980
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 2110455
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30