CMS Formulary

Displaying 130301-130310 of 1611142 results.
ID: 130301
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 404064
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130302
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1918042
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 130303
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1111641
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130304
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1487361
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 12
Qty Limit Days: 28
ID: 130305
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 351137
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130306
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 351136
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130307
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 199689
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130308
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 603208
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 130309
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 603203
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130310
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 603206
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30