CMS Formulary

Displaying 130341-130350 of 1611142 results.
ID: 130341
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1091225
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 130342
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 897696
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 130343
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 897702
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 130344
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 897710
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 130345
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 864706
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 30
ID: 130346
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1049611
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 130347
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1049618
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 130348
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 884535
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 130349
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 884532
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 130350
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 245136
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 15
Qty Limit Days: 30