CMS Formulary

Displaying 130461-130470 of 1611142 results.
ID: 130461
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197657
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130462
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 541878
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 130463
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 541892
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 130464
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 577961
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 130465
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 541363
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 130466
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 404059
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130467
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 404062
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130468
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 643488
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130469
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 404065
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130470
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 751868
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0