CMS Formulary

Displaying 133951-133960 of 1611142 results.
ID: 133951
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 238003
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 133952
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 403923
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 133953
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 198322
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133954
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 308962
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 133955
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 849395
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133956
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 991039
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133957
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 991194
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133958
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 991336
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133959
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 991044
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 133960
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 991188
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0