CMS Formulary

Displaying 130491-130500 of 1611142 results.
ID: 130491
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 977880
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130492
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 2047882
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130493
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 310190
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130494
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 310191
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130495
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 261178
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 130496
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 313941
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130497
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 198300
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130498
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 106303
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130499
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 313450
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130500
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 313451
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0