CMS Formulary

Displaying 131671-131680 of 1611142 results.
ID: 131671
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 2123137
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 131672
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 2123141
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 131673
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 2123145
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 131674
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1102277
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 131675
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 205918
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131676
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 205922
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131677
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 205924
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131678
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1721690
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131679
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 212219
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131680
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 213475
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0