CMS Formulary

Displaying 130761-130770 of 1611142 results.
ID: 130761
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197985
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130762
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197984
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130763
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 598006
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130764
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197650
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130765
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 861601
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130766
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 861597
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28
ID: 130767
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 615882
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130768
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 643070
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130769
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 855926
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130770
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 855906
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0