CMS Formulary

Displaying 130271-130280 of 1611142 results.
ID: 130271
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 892255
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130272
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 966270
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130273
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 349477
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130274
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 606726
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 130275
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 606730
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 130276
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 198324
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130277
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 198325
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130278
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 198323
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130279
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 855942
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130280
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 855863
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0