CMS Formulary

Displaying 130641-130650 of 1611142 results.
ID: 130641
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 349556
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130642
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 240741
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130643
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 309322
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130644
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 476576
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130645
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 617423
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130646
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 617993
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130647
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 745302
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130648
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 314227
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 12
Qty Limit Days: 30
ID: 130649
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 142046
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130650
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 244374
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0