CMS Formulary

Displaying 131571-131580 of 1611142 results.
ID: 131571
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 993456
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 180
ID: 131572
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1046402
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131573
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1649491
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 131574
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1649495
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 131575
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 2168596
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 450
Qty Limit Days: 30
ID: 131576
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 2045638
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 30
ID: 131577
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 2120195
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 30
ID: 131578
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1991509
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131579
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 858125
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131580
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 858127
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0