CMS Formulary

Displaying 131721-131730 of 1611142 results.
ID: 131721
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 198200
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131722
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 349514
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 131723
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 310261
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131724
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 308459
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131725
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 141963
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131726
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 309332
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 75
Qty Limit Days: 30
ID: 131727
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197519
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131728
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1000126
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131729
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1000153
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131730
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 198232
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0