CMS Formulary

Displaying 133021-133030 of 1611142 results.
ID: 133021
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 966158
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133022
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 966247
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133023
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 966171
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133024
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 966282
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133025
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 966250
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133026
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 847741
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 133027
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 966191
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133028
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 966201
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133029
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 966205
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133030
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 966251
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0