CMS Formulary

Displaying 130811-130820 of 1611142 results.
ID: 130811
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197527
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 130812
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197528
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 130813
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197529
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 300
Qty Limit Days: 30
ID: 130814
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 312744
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 130815
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 616487
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 130816
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 312962
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130817
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 349332
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130818
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 351250
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130819
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 856834
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130820
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 856845
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0