CMS Formulary

Displaying 131101-131110 of 1611142 results.
ID: 131101
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 895987
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131102
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 797274
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131103
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1597120
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131104
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1597126
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131105
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 310982
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 24
Qty Limit Days: 30
ID: 131106
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 313189
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131107
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 309290
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131108
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197362
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131109
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 313852
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131110
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 106336
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0