CMS Formulary

Displaying 131001-131010 of 1611142 results.
ID: 131001
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 198238
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131002
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1922720
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131003
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 905341
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131004
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 905347
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131005
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1650143
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131006
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1298910
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131007
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1298816
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131008
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1298906
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131009
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 858747
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131010
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 891881
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30