CMS Formulary

Displaying 130841-130850 of 1611142 results.
ID: 130841
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197636
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130842
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 260243
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130843
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 312641
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130844
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 905222
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130845
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 897683
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130846
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 314184
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130847
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 897722
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130848
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197942
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130849
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197941
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130850
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 861007
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 150
Qty Limit Days: 30