CMS Formulary

Displaying 133231-133240 of 1611142 results.
ID: 133231
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1870230
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 30
ID: 133232
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1870225
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 30
ID: 133233
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 242831
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133234
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 239239
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133235
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 856605
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133236
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 903857
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133237
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 856656
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133238
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 856660
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133239
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 856652
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133240
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 351133
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0