CMS Formulary

Displaying 133721-133730 of 1611142 results.
ID: 133721
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 977883
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133722
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 197863
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133723
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 197556
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133724
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 197554
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133725
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 197555
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133726
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 856369
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133727
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1009145
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 133728
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 687043
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 133729
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 577957
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 133730
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1000114
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0