CMS Formulary

Displaying 130671-130680 of 1611142 results.
ID: 130671
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 855336
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130672
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 855342
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130673
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 855348
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130674
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 855300
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130675
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1809730
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130676
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1809738
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130677
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1809667
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130678
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1233711
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130679
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 854228
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 18
Qty Limit Days: 30
ID: 130680
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 854235
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 24
Qty Limit Days: 30