CMS Formulary

Displaying 130791-130800 of 1611142 results.
ID: 130791
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 199247
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 130792
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 314231
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130793
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 312961
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130794
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 198211
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130795
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 200060
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130796
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 317573
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 130797
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 312440
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130798
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 312441
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130799
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 199123
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130800
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197956
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0