CMS Formulary

Displaying 130191-130200 of 1611142 results.
ID: 130191
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1486977
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130192
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1940498
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 130193
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1593831
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130194
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1593833
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 130195
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1593835
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130196
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1593775
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130197
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1990869
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 3
Qty Limit Days: 28
ID: 130198
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 861045
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130199
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 861043
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130200
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 206347
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0