CMS Formulary

Displaying 131771-131780 of 1611142 results.
ID: 131771
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 313919
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 3
Qty Limit Days: 28
ID: 131772
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1797867
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131773
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 860107
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131774
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 904481
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 131775
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 260218
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 131776
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 205324
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 131777
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 617312
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 131778
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 617310
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 131779
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 617311
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 131780
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 310818
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0