CMS Formulary

Displaying 130011-130020 of 1611142 results.
ID: 130011
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1098678
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130012
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 904467
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130013
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 904475
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130014
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1490065
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130015
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 199058
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130016
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 596843
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 130017
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 308868
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130018
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 403879
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 130019
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 476556
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130020
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197535
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0