CMS Formulary

Displaying 130951-130960 of 1611142 results.
ID: 130951
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 242438
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130952
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 200094
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 130953
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 200095
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130954
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 200096
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130955
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197311
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130956
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197313
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130957
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 313566
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 130958
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 485434
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130959
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 485436
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130960
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 859424
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30