CMS Formulary

Displaying 130121-130130 of 1611142 results.
ID: 130121
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 852877
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130122
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197979
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130123
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197978
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130124
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1666334
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 130125
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1116639
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 130126
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 966524
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 30
ID: 130127
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 966529
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 30
ID: 130128
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1539762
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130129
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 991233
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 130130
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 308047
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30