CMS Formulary

Displaying 130701-130710 of 1611142 results.
ID: 130701
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1946529
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130702
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1946527
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130703
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1946525
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130704
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 966920
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130705
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 801054
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130706
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 206548
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130707
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1540356
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130708
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 992475
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130709
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 995258
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130710
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1049621
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 30