CMS Formulary

Displaying 130971-130980 of 1611142 results.
ID: 130971
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 200284
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130972
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 312076
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130973
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 351108
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130974
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 349251
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130975
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1095712
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 130976
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1665515
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130977
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1719286
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130978
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 2045201
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130979
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 313115
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130980
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 239240
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0