CMS Formulary

Displaying 131281-131290 of 1611142 results.
ID: 131281
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 2058946
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131282
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1722376
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 131283
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 2100099
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 30
ID: 131284
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 2100100
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 30
ID: 131285
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 312614
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131286
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 283077
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131287
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 993755
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4500
Qty Limit Days: 30
ID: 131288
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197448
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131289
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1923432
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131290
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 477391
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0