CMS Formulary

Displaying 129991-130000 of 1611142 results.
ID: 129991
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 643066
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 129992
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1652084
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129993
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1006801
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 129994
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 996921
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 129995
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 721773
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 129996
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 476179
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 129997
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 476177
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 270
Qty Limit Days: 30
ID: 129998
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 199703
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 129999
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 485440
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130000
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 899511
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0