CMS Formulary

Displaying 130401-130410 of 1611142 results.
ID: 130401
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 2052704
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130402
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 2105817
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 130403
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1300797
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130404
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1300803
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130405
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 967388
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130406
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 307730
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130407
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 106302
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130408
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 884308
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130409
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 106387
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130410
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 308714
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0