CMS Formulary

Displaying 133701-133710 of 1611142 results.
ID: 133701
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 865123
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133702
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 860918
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133703
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 859841
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133704
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 313159
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 12
Qty Limit Days: 30
ID: 133705
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 197516
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133706
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 197517
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133707
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 996740
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 300
Qty Limit Days: 30
ID: 133708
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 311369
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 320
Qty Limit Days: 30
ID: 133709
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1482908
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 133710
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 310497
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0