CMS Formulary

Displaying 130831-130840 of 1611142 results.
ID: 130831
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 856364
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130832
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 863636
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130833
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 863619
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 130834
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 863628
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 130835
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 314080
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130836
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1190655
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130837
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 545236
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130838
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1724340
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130839
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 312075
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130840
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 308345
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0