CMS Formulary

Displaying 130731-130740 of 1611142 results.
ID: 130731
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 993890
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 390
Qty Limit Days: 30
ID: 130732
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 864718
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 130733
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197593
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130734
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 199168
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130735
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 312357
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130736
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 312362
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130737
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 2106334
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 0
Qty Limit Days: 1
ID: 130738
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1661220
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130739
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1809580
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130740
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 854876
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30