CMS Formulary

Displaying 133871-133880 of 1611142 results.
ID: 133871
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 702519
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133872
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 314182
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133873
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 885219
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133874
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 885213
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133875
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1049635
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 30
ID: 133876
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 198086
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133877
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 199167
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133878
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 199164
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133879
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 763181
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133880
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 763179
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0