CMS Formulary

Displaying 133211-133220 of 1611142 results.
ID: 133211
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 310295
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 133212
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 310297
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 133213
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 313992
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 133214
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 313993
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 133215
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 310293
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 133216
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 310294
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 133217
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1299903
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133218
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 2000695
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133219
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1299909
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133220
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 197507
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0