CMS Formulary

Displaying 131381-131390 of 1611142 results.
ID: 131381
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 861487
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131382
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1992281
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131383
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 203088
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 131384
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 313227
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131385
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 313226
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131386
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 308715
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131387
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 848208
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131388
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 848176
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131389
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 848178
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131390
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1191310
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0