CMS Formulary

Displaying 130061-130070 of 1611142 results.
ID: 130061
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 995156
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 1200
Qty Limit Days: 30
ID: 130062
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197604
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130063
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197606
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130064
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 198089
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130065
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 198083
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130066
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 314055
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130067
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1550940
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 130068
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1655960
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130069
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 859824
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130070
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 309101
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0