CMS Formulary

Displaying 131351-131360 of 1611142 results.
ID: 131351
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1193353
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 131352
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 2359344
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 131353
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 2359348
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 131354
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 2359340
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 131355
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 2361300
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 30
ID: 131356
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 2361296
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 131357
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1243052
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 131358
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1606866
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 131359
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1606870
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 131360
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 2053519
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 56
Qty Limit Days: 28