CMS Formulary

Displaying 131401-131410 of 1611142 results.
ID: 131401
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 308973
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131402
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 858824
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 131403
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 858828
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 131404
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 308976
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131405
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 310379
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131406
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 310380
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131407
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1313112
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131408
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 855671
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131409
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 311679
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131410
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 105583
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0