CMS Formulary

Displaying 130151-130160 of 1611142 results.
ID: 130151
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1801295
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130152
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 2123111
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130153
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 198071
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130154
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197541
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 130155
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 753478
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130156
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 753479
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130157
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1428933
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130158
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1091828
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130159
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 351173
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130160
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 351174
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0