CMS Formulary

Displaying 131261-131270 of 1611142 results.
ID: 131261
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 198369
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131262
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 198370
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131263
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1659803
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131264
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1242819
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 3
Qty Limit Days: 30
ID: 131265
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1242815
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 30
ID: 131266
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 616749
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 131267
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 728231
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 131268
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1657212
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131269
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1147228
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 131270
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 2197873
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 150
Qty Limit Days: 30