CMS Formulary

Displaying 130021-130030 of 1611142 results.
ID: 130021
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 310295
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 130022
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 310297
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 130023
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 313992
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 130024
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 313993
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 130025
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 310293
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 130026
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 310294
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 130027
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1299903
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130028
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 2000695
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130029
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1299909
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130030
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1362706
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0