CMS Formulary

Displaying 132121-132130 of 1611142 results.
ID: 132121
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 283485
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 132122
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 756209
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1920
Qty Limit Days: 30
ID: 132123
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 311943
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 1200
Qty Limit Days: 30
ID: 132124
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 313850
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 132125
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 313222
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 132126
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 309076
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 132127
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 309078
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 132128
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 198352
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 132129
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 200031
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 132130
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 200033
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0