CMS Formulary

Displaying 130441-130450 of 1611142 results.
ID: 130441
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 349196
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 130442
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 349197
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 300
Qty Limit Days: 30
ID: 130443
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 905516
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130444
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 905495
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130445
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 835913
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130446
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1000405
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130447
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 995232
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130448
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197863
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130449
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197556
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130450
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197554
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0