CMS Formulary

Displaying 130091-130100 of 1611142 results.
ID: 130091
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197590
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 130092
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197591
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 130093
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197589
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 130094
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197391
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130095
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197392
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130096
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 597852
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130097
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 597850
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130098
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 310273
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130099
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 284245
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130100
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 835886
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0