CMS Formulary

Displaying 130481-130490 of 1611142 results.
ID: 130481
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1095362
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130482
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 753482
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130483
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 750268
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130484
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 761977
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130485
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 750265
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130486
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 762001
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130487
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 753483
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130488
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 801185
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130489
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 898362
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130490
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 312529
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0