CMS Formulary

Displaying 130451-130460 of 1611142 results.
ID: 130451
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197555
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130452
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1009145
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 130453
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 687043
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 130454
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 577957
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 130455
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1000114
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130456
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 199159
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130457
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1000135
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130458
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1000141
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130459
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197658
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130460
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197659
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0