CMS Formulary

Displaying 130721-130730 of 1611142 results.
ID: 130721
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1307058
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 130722
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1010606
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 130723
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1307063
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 130724
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 314111
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130725
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 858798
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 150
Qty Limit Days: 30
ID: 130726
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 311725
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130727
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 311726
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130728
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 884386
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 130729
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 884385
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 130730
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 993770
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 390
Qty Limit Days: 30