CMS Formulary

Displaying 130851-130860 of 1611142 results.
ID: 130851
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 861010
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 130852
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 861004
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 75
Qty Limit Days: 30
ID: 130853
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 861731
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 130854
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 562524
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130855
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1652673
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130856
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1649429
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130857
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1650142
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130858
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 353538
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130859
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1723156
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130860
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 897666
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0