CMS Formulary

Displaying 130751-130760 of 1611142 results.
ID: 130751
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 858625
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130752
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 855182
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130753
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 855189
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130754
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 602964
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130755
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 402131
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130756
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 349545
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130757
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 349490
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130758
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 349553
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130759
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 349547
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130760
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 856373
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0