CMS Formulary

Displaying 131391-131400 of 1611142 results.
ID: 131391
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 313200
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131392
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 103456
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131393
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 310891
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131394
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 308979
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131395
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197303
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131396
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197304
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131397
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197853
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131398
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 858813
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 131399
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 858817
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 131400
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 858810
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30