CMS Formulary

Displaying 130351-130360 of 1611142 results.
ID: 130351
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 245134
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 15
Qty Limit Days: 30
ID: 130352
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 245135
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 15
Qty Limit Days: 30
ID: 130353
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197696
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 15
Qty Limit Days: 30
ID: 130354
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1870650
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130355
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 829762
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130356
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1191234
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130357
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1724338
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130358
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1658637
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130359
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 307718
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130360
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 307719
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0