CMS Formulary

Displaying 133791-133800 of 1611142 results.
ID: 133791
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 861427
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133792
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 991086
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133793
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 314006
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 133794
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 315107
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 133795
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 310489
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 133796
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 250344
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133797
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 722122
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 133798
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 722116
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 133799
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 198250
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133800
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 197502
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0