CMS Formulary

Displaying 133161-133170 of 1611142 results.
ID: 133161
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 884707
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 133162
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 753543
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133163
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 2110455
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 133164
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1918209
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 30
ID: 133165
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1918194
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 30
ID: 133166
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1918203
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 30
ID: 133167
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 904870
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 133168
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 904876
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 133169
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1314763
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 133170
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 312594
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0