CMS Formulary

Displaying 130281-130290 of 1611142 results.
ID: 130281
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 313366
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130282
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1000070
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130283
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1536586
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130284
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 242333
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 130285
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 241527
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 130286
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 403922
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 130287
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 402109
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 130288
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 855875
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130289
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 834235
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130290
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 834241
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0