CMS Formulary

Displaying 133911-133920 of 1611142 results.
ID: 133911
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 308191
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133912
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 899461
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133913
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 899485
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133914
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1101926
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133915
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 899495
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133916
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1101932
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133917
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 199119
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 133918
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1793916
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 6
Qty Limit Days: 30
ID: 133919
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1657173
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 6
Qty Limit Days: 30
ID: 133920
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1657160
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 6
Qty Limit Days: 30