CMS Formulary

Displaying 130611-130620 of 1611142 results.
ID: 130611
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 403810
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130612
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 403811
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130613
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 308191
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130614
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 899461
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130615
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 899485
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130616
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1101926
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130617
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 899495
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130618
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1101932
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130619
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 199119
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 130620
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1793916
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 6
Qty Limit Days: 30