CMS Formulary

Displaying 130781-130790 of 1611142 results.
ID: 130781
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1487086
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130782
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1539953
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130783
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1539955
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130784
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1605086
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130785
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 904419
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130786
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 866436
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130787
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 855633
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130788
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1607784
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130789
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 199245
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 130790
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 199246
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30