CMS Formulary

Displaying 132881-132890 of 1611142 results.
ID: 132881
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1874559
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 132882
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1874553
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 132883
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 900575
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 30
ID: 132884
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 977427
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 132885
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 977434
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 132886
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 977438
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 132887
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1304979
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 132888
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 892625
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 300
Qty Limit Days: 30
ID: 132889
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 311355
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 132890
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 197893
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0