CMS Formulary

Displaying 130651-130660 of 1611142 results.
ID: 130651
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 238004
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 130652
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 313921
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130653
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 238003
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 130654
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 403923
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 130655
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 198322
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130656
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 991039
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130657
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 991194
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130658
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 991336
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130659
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 991044
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130660
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 991188
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0