CMS Formulary

Displaying 130511-130520 of 1611142 results.
ID: 130511
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 310812
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130512
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 861427
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130513
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 991086
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130514
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 314006
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 130515
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 315107
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 130516
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 310489
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 130517
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 250344
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130518
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 198250
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130519
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197502
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130520
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 863559
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 1080
Qty Limit Days: 30