CMS Formulary

Displaying 130961-130970 of 1611142 results.
ID: 130961
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 859747
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130962
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 859751
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130963
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 859419
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130964
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 997226
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130965
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 997220
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 130966
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 349201
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 130967
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 200034
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130968
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 312078
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130969
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 314154
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130970
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 283639
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30