CMS Formulary

Displaying 130501-130510 of 1611142 results.
ID: 130501
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 308508
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130502
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 310149
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130503
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1000673
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130504
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 284254
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130505
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197900
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 130506
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197901
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 130507
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197902
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 150
Qty Limit Days: 30
ID: 130508
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 311386
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130509
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 311385
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130510
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 314075
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0