CMS Formulary

Displaying 131151-131160 of 1611142 results.
ID: 131151
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 311995
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131152
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1648759
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131153
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 903847
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131154
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1307061
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 131155
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1115698
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 780
Qty Limit Days: 30
ID: 131156
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1308569
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 131157
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 351209
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131158
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 310362
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131159
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197623
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131160
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1435115
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28