CMS Formulary

Displaying 130241-130250 of 1611142 results.
ID: 130241
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197464
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 130242
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1298861
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130243
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1298870
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130244
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 314034
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130245
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 198284
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130246
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197316
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130247
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 310671
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130248
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 310670
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130249
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197318
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130250
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 313354
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0