CMS Formulary

Displaying 130381-130390 of 1611142 results.
ID: 130381
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1086780
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130382
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1086786
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130383
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1307415
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130384
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1307421
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130385
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1869699
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130386
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 833151
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130387
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 833139
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130388
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 833143
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130389
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 833149
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130390
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 833146
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0