CMS Formulary

Displaying 130691-130700 of 1611142 results.
ID: 130691
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 2102715
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 130692
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 348506
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130693
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1719862
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130694
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1719803
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130695
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 866103
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130696
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 672567
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130697
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 672569
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 130698
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 672571
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130699
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 993541
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130700
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 993557
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0