CMS Formulary

Displaying 131871-131880 of 1611142 results.
ID: 131871
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 404587
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 131872
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 616148
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 850
Qty Limit Days: 30
ID: 131873
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 639888
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 131874
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1744003
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 131875
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1744007
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 131876
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1744011
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 131877
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 901614
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 131878
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1147337
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 131879
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1306298
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 131880
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1551999
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30