CMS Formulary

Displaying 133421-133430 of 1611142 results.
ID: 133421
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 2387331
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 10
Qty Limit Days: 30
ID: 133422
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1486981
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 133423
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1486977
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 133424
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1940498
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 133425
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1593831
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 133426
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1593833
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 133427
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1593835
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 133428
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1593775
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 133429
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 847917
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 30
ID: 133430
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 847913
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 30