CMS Formulary

Displaying 132281-132290 of 1611142 results.
ID: 132281
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 892672
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 132282
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1923822
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 132283
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1923828
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 132284
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1923826
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 132285
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1490026
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 132286
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1490034
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 132287
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1490038
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 132288
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1597620
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 132289
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 313580
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 132290
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1486691
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0