CMS Formulary

Displaying 131301-131310 of 1611142 results.
ID: 131301
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1439903
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131302
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 2105657
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 131303
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 2105645
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 131304
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 2105653
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 600
Qty Limit Days: 30
ID: 131305
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 2180336
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 131306
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 615979
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131307
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 402252
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131308
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 207059
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 15
Qty Limit Days: 30
ID: 131309
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 211140
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131310
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 706831
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0