CMS Formulary

Displaying 130431-130440 of 1611142 results.
ID: 130431
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 313159
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 12
Qty Limit Days: 30
ID: 130432
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197516
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130433
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197517
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130434
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 996740
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 300
Qty Limit Days: 30
ID: 130435
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 311369
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 320
Qty Limit Days: 30
ID: 130436
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1482908
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 130437
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 310497
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130438
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 905369
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130439
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 311166
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130440
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197832
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0