CMS Formulary

Displaying 131361-131370 of 1611142 results.
ID: 131361
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 2166401
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 131362
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1812470
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 112
Qty Limit Days: 28
ID: 131363
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1655934
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 112
Qty Limit Days: 28
ID: 131364
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 2053512
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 56
Qty Limit Days: 28
ID: 131365
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 904447
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131366
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 284592
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131367
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 284594
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131368
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 284593
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131369
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 284595
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131370
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 904158
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0